Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA.
Ann Emerg Med. 2013 Jan;61(1):9-17. doi: 10.1016/j.annemergmed.2012.07.112. Epub 2012 Nov 9.
We determine the test performance characteristics for point-of-care ultrasonography performed by pediatric emergency physicians compared with radiographic diagnosis of elbow fractures and compare interobserver agreement between enrolling physicians and an experienced pediatric emergency medicine sonologist.
This was a prospective study of children aged up to 21 years and presenting to the emergency department (ED) with elbow injuries requiring radiographs. Before obtaining radiographs, pediatric emergency physicians performed focused elbow ultrasonography. An ultrasonographic result positive for fracture at the elbow was defined as the pediatric emergency physician's determination of an elevated posterior fat pad or lipohemarthrosis of the posterior fat pad. All patients received an elbow radiograph in the ED and clinical follow-up. The criterion standard for fracture was fracture on initial or follow-up radiographs.
One hundred thirty patients with a mean age of 7.5 years were enrolled by 26 sonologists. Forty-three (33%) patients had a radiograph result positive for fracture. A positive elbow ultrasonographic result had a sensitivity of 98% (95% confidence interval [CI] 88% to 100%), specificity of 70% (95% CI 60% to 79%), positive likelihood ratio of 3.3 (95% CI 2.4 to 4.5), and negative likelihood ratio of 0.03 (95% CI 0.01 to 0.23) for fracture. The interobserver agreement (κ) was 0.77. The use of elbow ultrasonography would reduce radiographs in 48% of patients but would miss 1 fracture.
Point-of-care ultrasonography is highly sensitive for elbow fractures, and a negative ultrasonographic result may reduce the need for radiographs in children with elbow injuries. Elbow ultrasonography may be useful in settings in which radiography is not readily accessible or is time consuming to obtain.
我们确定儿科急诊医生进行即时超声检查与放射诊断肘部骨折的检测性能特征，并比较入组医生与经验丰富的儿科急诊超声医生之间的观察者间一致性。
这是一项前瞻性研究，纳入年龄在 21 岁以下、因肘部受伤需要放射检查而就诊于急诊科的儿童。在获得放射检查之前，儿科急诊医生进行了肘部焦点超声检查。肘部超声检查结果阳性提示骨折定义为儿科急诊医生判断后脂肪垫抬高或后脂肪垫脂肪血。所有患者在急诊科接受肘部 X 线检查和临床随访。骨折的标准诊断为初始或随访 X 线片上的骨折。
由 26 名超声医生纳入了 130 名平均年龄为 7.5 岁的患者。43 名（33%）患者的放射检查结果为阳性提示骨折。阳性肘部超声检查结果的敏感性为 98%（95%置信区间 88%至 100%），特异性为 70%（95%置信区间 60%至 79%），阳性似然比为 3.3（95%置信区间 2.4 至 4.5），阴性似然比为 0.03（95%置信区间 0.01 至 0.23）。观察者间一致性（κ）为 0.77。即时超声检查的应用可使 48%的患者减少放射检查，但会漏诊 1 例骨折。
即时超声检查对肘部骨折具有高度敏感性，阴性超声检查结果可能减少肘部受伤儿童的放射检查需求。即时超声检查可能在放射检查不易获得或获取时间较长的情况下有用。
