scholarly journals Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes

2017 ◽  
Vol 24 (5) ◽  
pp. 607-616 ◽  
Author(s):  
Naveen Poonai ◽  
Frank Myslik ◽  
Gary Joubert ◽  
Josiah Fan ◽  
Amita Misir ◽  
...  
Keyword(s):  
Test Performance ◽  
Point Of Care ◽  
Performance Characteristics ◽  
Point Of Care Ultrasound ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Patient Centered ◽  
Fractures In Children ◽  
Distal Forearm Fractures

Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study

2019 ◽  
Vol 36 (10) ◽  
pp. 613-616 ◽  
Author(s):  
Anniek C Epema ◽  
Mariëlle J B Spanjer ◽  
Lieselotte Ras ◽  
Johannes C Kelder ◽  
Marieke Sanders
Keyword(s):  
The Netherlands ◽  
Diagnostic Accuracy ◽  
Conventional Radiography ◽  
Point Of Care Ultrasound ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Predictive Values ◽  
Pain Scores ◽  
Fractures In Children ◽  
Distal Forearm Fractures

BackgroundDistal forearm fractures are common in children. The reference standard to diagnose these fractures is by conventional radiography, which exposes these patients to harmful radiation. Ultrasound (US) seems to be a good alternative. However, emergency physicians (EPs) in the Netherlands have limited experience in using US for diagnosing fractures in children.ObjectiveThe primary objective was to determine the accuracy of US, performed by a Dutch EP, compared with conventional radiography, in diagnosing distal forearm fractures in children. As a secondary objective, differences in pain scores during the performance of both US and plain radiography were determined.MethodsChildren, aged between 0 and 14 years old, suspected of having a distal forearm fracture were enrolled at the Emergency Department. US and radiographic findings were compared. Statistics for accuracy were calculated. Pain scores were recorded during US and radiography and compared as well. All participating operators received an hour-long pretrial training.Results100 patients were enrolled. The mean age was 9.5 years (SD, 3.6), and 50% were women. Overall diagnostic accuracy was 92% (95% CI 85%-96%). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios for US were 95% (95% CI 87% to 99%), 86% (95% CI 71% to 95%), 92% (95% CI 83% to 97%), 91% (95% CI 76% to 98%), 6.86 (95% CI 3.04 to 15.51) and 0.05 (95% CI 0.02 to 0.17), respectively. The pain scores during US and radiographic imaging were 3.3 and 4.6, respectively (p<0.01).ConclusionsIn this study, we showed that US is an accurate method for diagnosing distal forearm fractures in children. The main advantages are that it is radiation-free and rapidly practicable, and that patients experience it as less painful than radiography. Moreover, this study has proven that with minimal experience in US, good diagnostic accuracy can be achieved after brief training.

scholarly journals Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study

2020 ◽  
pp. emermed-2020-209689
Author(s):  
Peter J Snelling ◽  
Philip Jones ◽  
Gerben Keijzers ◽  
David Bade ◽  
David W Herd ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Nurse Practitioners ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Diagnostic Study ◽  
X Rays ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
X Ray ◽  
Distal Forearm Fractures

BackgroundPaediatric distal forearm fractures are a common ED presentation. They can be diagnosed with point-of-care ultrasound (POCUS) as an alternative to X-rays. Given that ED nurse practitioners (NPs) are relied on for the diagnosis of paediatric fractures, it is important to describe the diagnostic accuracy of NP-conducted POCUS versus X-ray.MethodsThis prospective diagnostic study was conducted in a tertiary paediatric hospital in Queensland, Australia, between February 2018 and April 2019. Participants were children aged 4–16 years with a clinically non-angulated, suspected distal forearm fracture. Diagnosis from 6-view NP-administered POCUS of the distal radius and ulna was compared against the reference standard of 2-view X-ray. Each patient received both imaging modalities. Overall forearm diagnosis was classified as ‘no’, ‘buckle’ or ‘other’ fracture for both modalities. The primary outcome was diagnostic accuracy for ‘any’ fracture (‘buckle’ and ‘other’ fractures combined). Secondary outcomes included diagnostic accuracy for ‘other’ fractures versus ‘buckle’ and ‘no’ fractures combined, and pain, imaging duration and preference for modality.ResultsOf 204 recruited patients, 129 had X-ray-diagnosed forearm fractures. The sensitivity and specificity for NP-administered POCUS were 94.6% (95% CI 89.2% to 97.3%) and 85.3% (95% CI 75.6% to 91.6%), respectively. ‘Other’ fractures (mostly cortical breach fractures), when compared with ‘buckle’/ ‘no’ fractures, had sensitivity 81.0% (95% CI 69.1% to 89.1%) and specificity 95.9% (95% CI 91.3% to 98.1%). Pain and imaging duration were clinically similar between modalities. There was a preference for POCUS by patients, parents and NPs.ConclusionsNP-administered POCUS had clinically acceptable diagnostic accuracy for paediatric patients presenting with non-angulated distal forearm injuries. This included good sensitivity for diagnosis of ‘any’ fracture and good specificity for diagnosis of cortical breach fractures alone. Given the preference for POCUS, and the lack of difference in pain and duration between modalities, future research should consider functional outcomes comparing POCUS with X-ray in this population in a randomised controlled trial.

Plaster cast treatment for distal forearm fractures in children

2020 ◽  
Vol 29 (2) ◽  
pp. 179-186
Author(s):  
Domenico Ravier ◽  
Ilaria Morelli ◽  
Valentina Buscarino ◽  
Chiara Mattiuz ◽  
Luca M. Sconfienza ◽  
...  
Keyword(s):  
Plaster Cast ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Fractures In Children ◽  
Distal Forearm Fractures
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