Jones Sarah, Colaco Keith, Fischer Jason, Stimec Jennifer, Kwan Charisse, Boutis Kathy
Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.
Pediatr Emerg Care. 2018 Dec;34(12):842-847. doi: 10.1097/PEC.0000000000001130.
In children with radiograph fracture-negative lateral ankle injuries, the main objective of this pilot study was to explore the accuracy, sensitivity, and specificity of point-of-care ultrasound (POCUS) performed by a pediatric emergency physician in diagnosing anterior talofibular ligament injuries, radiographically occult distal fibular fractures, and effusions compared with reference standard magnetic resonance imaging (MRI).
This was a prospective cohort pilot study. Children aged 5 to 17 years with an isolated, acute lateral ankle injury and fracture-negative ankle radiographs were eligible for enrolment. Within 1 week of the injury, enrolled children returned for MRI and POCUS of both ankles.
Seven children were enrolled, with a mean age 12.1 (SD, 3.0) years. Overall, POCUS agreed with MRI with respect to anterior talofibular ligament injury in 4 (57%) of 7 cases. Of the 2 cases with MRI-confirmed ligament damage, POCUS accurately identified and graded the extent of ligament damage in 1 case. Point-of-care ultrasound falsely identified ligament injuries in 2 cases. Both imaging modalities confirmed the absence of cortical fractures in all 7 cases. For all findings, POCUS sensitivity and specificity were 57% and 86%, respectively.
In this pilot study, we established that POCUS diagnosed the specific pathology of radiograph-negative lateral ankle injuries with poor sensitivity but good specificity. Thus, POCUS could act as a tool to exclude significant ligamentous and radiographically occult bony injury in these cases. A larger study is needed to validate the utility of POCUS for this common injury.
在踝关节外侧损伤X线片显示无骨折的儿童中，本初步研究的主要目的是探讨儿科急诊医师进行的即时超声检查（POCUS）在诊断距腓前韧带损伤、X线片隐匿性腓骨远端骨折和积液方面与参考标准磁共振成像（MRI）相比的准确性、敏感性和特异性。
这是一项前瞻性队列初步研究。年龄在5至17岁、孤立急性踝关节外侧损伤且踝关节X线片显示无骨折的儿童符合入组条件。在受伤后1周内，入组儿童返回进行双踝关节的MRI和POCUS检查。
7名儿童入组，平均年龄12.1（标准差3.0）岁。总体而言，7例中有4例（57%）的距腓前韧带损伤POCUS与MRI结果一致。在2例经MRI证实韧带损伤的病例中，POCUS准确识别并分级了1例韧带损伤的程度。POCUS在2例假阳性诊断为韧带损伤。两种成像方式均证实所有7例均无皮质骨折。对于所有检查结果，POCUS的敏感性和特异性分别为57%和86%。
在本初步研究中，我们发现POCUS诊断X线片阴性的踝关节外侧损伤的特定病理情况时敏感性较差但特异性良好。因此，在这些病例中POCUS可作为排除严重韧带损伤和X线片隐匿性骨损伤的工具。需要更大规模的研究来验证POCUS对这种常见损伤的实用性。
