Chien Ming, Bulloch Blake, Garcia-Filion Pamela, Youssfi Mostafa, Shrader Michael W, Segal Lee S
Division of Pediatric Emergency Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
Pediatr Emerg Care. 2011 Nov;27(11):1038-41. doi: 10.1097/PEC.0b013e318235e965.
The objective of the study was to determine the diagnostic accuracy of pediatric emergency physicians in diagnosing clavicle fractures by bedside ultrasound (US).
This was a prospective study of pediatric emergency department (ED) patients with suspected clavicle fractures conducted in a tertiary-care, freestanding pediatric hospital. A convenience sample of patients younger than 17 years underwent bedside US for detection of clavicle fracture by pediatric emergency physicians with limited US training. Ultrasound findings were compared with standard radiographs, which were considered the criterion standard. Pain scores using the validated color analog scale (0-10) were determined before and during US. Total length of stay in the ED, time to US, and time to radiograph were recorded.
Fifty-eight patients were enrolled, of which 39 (67%) had fracture determined by radiograph. Ultrasound interpretation gave a sensitivity of 89.7% (95% confidence interval [CI], 75.8%-97.1%) and specificity of 89.5% (95% CI, 66.9%-98.7%). Positive and negative predictive values were 94.6% (95% CI, 81.8%-99.3%) and 81.0% (95% CI, 58.1%-94.5%), respectively. Positive and negative likelihood ratios were 8.33 and 0.11, respectively. Pain scores averaged 4.7 before US and 5.2 during US (P = 0.204). There was a statistically significant difference between mean time to US (76 minutes) and mean time to radiograph (107 minutes) (P < 0.001).
Pediatric emergency physicians with minimal formal training can accurately diagnose clavicle fractures by US. In addition, US itself is not associated with an increase in pain and may reduce length of stay in the ED.
本研究的目的是确定儿科急诊医师通过床边超声（US）诊断锁骨骨折的诊断准确性。
这是一项在一家独立的三级儿科医院对疑似锁骨骨折的儿科急诊科（ED）患者进行的前瞻性研究。对年龄小于17岁的便利样本患者，由接受过有限超声培训的儿科急诊医师进行床边超声检查以检测锁骨骨折。将超声检查结果与标准X线片进行比较，标准X线片被视为标准对照。在超声检查前和检查期间，使用经过验证的彩色模拟量表（0 - 10）确定疼痛评分。记录在急诊科的总住院时间、超声检查时间和X线检查时间。
共纳入58例患者，其中39例（67%）经X线片确诊为骨折。超声检查的敏感性为89.7%（95%置信区间[CI]，75.8% - 97.1%），特异性为89.5%（95%CI，66.9% - 98.7%）。阳性预测值和阴性预测值分别为94.6%（95%CI，81.8% - 99.3%）和81.0%（95%CI，58.1% - 94.5%）。阳性似然比和阴性似然比分别为8.33和0.11。超声检查前疼痛评分平均为4.7，检查期间为5.2（P = 0.204）。超声检查平均时间（76分钟）与X线检查平均时间（107分钟）之间存在统计学显著差异（P < 0.001）。
接受最少正规培训的儿科急诊医师可以通过超声准确诊断锁骨骨折。此外，超声检查本身不会增加疼痛，且可能缩短在急诊科的住院时间。
