Poonai Naveen, Myslik Frank, Joubert Gary, Fan Josiah, Misir Amita, Istasy Victor, Columbus Melanie, Soegtrop Robert, Goldfarb Alex, Thompson Drew, Dubrovsky Alexander Sasha
Department of Pediatrics, Western University, London, Ontario.
Division of Emergency Medicine, Western University, London, Ontario.
Acad Emerg Med. 2017 May;24(5):607-616. doi: 10.1111/acem.13146. Epub 2017 Apr 27.
Distal forearm fractures are the most common fracture type in children. Point-of-care-ultrasound (POCUS) is increasingly being used, and preliminary studies suggest that it offers an accurate approach to diagnosis. However, outcomes such as pain, satisfaction, and procedure duration have not been explored but may be salient to the widespread acceptance of this technology by caregivers and children. Our objectives were to examine the test performance characteristics of POCUS for nonangulated distal forearm injuries in children and compare POCUS to x-ray with respect to pain, caregiver satisfaction, and procedure duration.
We conducted a cross-sectional study involving children aged 4-17 years with a suspected nonangulated distal forearm fracture. Participants underwent both x-ray and POCUS assessment. The primary outcome was sensitivity between POCUS and x-ray, the reference standard. Secondary outcomes included self-reported pain using the Faces Pain Scale-Revised, caregiver satisfaction using a five-item Likert scale, and procedure duration.
POCUS was performed in 169 children of whom 76 were diagnosed with a fracture including 61 buckle fractures. Sensitivity of POCUS for distal forearm fractures was 94.7% (95% confidence interval [CI] = 89.7-99.8) and specificity was 93.5% (95% CI = 88.6-98.5). POCUS was associated with a significantly lower median (interquartile range [IQR]) pain score compared to x-ray: 1 (0-2) versus 2 (1-3), respectively (median difference = 0.5; 95% CI = 0.5-1; p < 0.001) and no significant difference in median (IQR) caregiver satisfaction score: 5 (0) versus 5 (4-5), respectively (median difference = 0, 95% CI = 0, p = 1.0). POCUS was associated with a significantly lower median (IQR) procedure duration versus x-ray: 1.5 (0.8-2.2) minutes versus 27 (15-58) minutes, respectively (median difference = 34.1, 95% CI = 26.8-41.5, p < 0.001).
Our findings suggest that POCUS assessment of distal forearm injuries in children is accurate, timely, and associated with low levels of pain and high caregiver satisfaction.
儿童前臂远端骨折是最常见的骨折类型。床旁超声（POCUS）的应用越来越广泛，初步研究表明其提供了一种准确的诊断方法。然而，疼痛、满意度和检查时长等结果尚未得到研究，但可能对护理人员和儿童广泛接受这项技术至关重要。我们的目的是研究POCUS对儿童非成角前臂远端损伤的检测性能特征，并在疼痛、护理人员满意度和检查时长方面将POCUS与X线进行比较。
我们进行了一项横断面研究，纳入了4至17岁疑似非成角前臂远端骨折的儿童。参与者同时接受了X线和POCUS评估。主要结果是POCUS与作为参考标准的X线之间的敏感性。次要结果包括使用面部疼痛量表修订版进行的自我报告疼痛、使用五点李克特量表进行的护理人员满意度以及检查时长。
对169名儿童进行了POCUS检查，其中76名被诊断为骨折，包括61例青枝骨折。POCUS对前臂远端骨折的敏感性为94.7%（95%置信区间[CI]=89.7-99.8），特异性为93.5%（95%CI=88.6-98.5）。与X线相比，POCUS的中位（四分位间距[IQR]）疼痛评分显著更低：分别为1（0-2）和2（1-3）（中位差异=0.5；95%CI=0.5-1；p<0.001），护理人员满意度中位（IQR）评分无显著差异：分别为5（0）和5（4-5）（中位差异=0，95%CI=0，p=1.0）。与X线相比，POCUS的中位（IQR）检查时长显著更短：分别为1.5（0.8-2.2）分钟和2（15-58）分钟（中位差异=34.1，95%CI=26.8-41.5，p<0.001）。
我们的研究结果表明，POCUS对儿童前臂远端损伤的评估准确、及时，且疼痛程度低，护理人员满意度高。
