Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Emerg Radiol. 2021 Jun;28(3):565-572. doi: 10.1007/s10140-020-01897-9. Epub 2021 Jan 15.
The purpose of this study was to systematically investigate the performance of different radiographic views in the identification of scaphoid fractures in children.
This case-control study compared 4-view radiographic examinations of the wrist between children with scaphoid fracture and age- and sex-matched children without fractures performed between January 2008 and July 2019. After randomization, each examination was reviewed 3 times, at least 1 week apart, first using each view separately and later using multiple views without (3-view) and with the posteroanterior (PA) scaphoid view (4-view), to determine the presence or absence of a scaphoid fracture. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with inter-rater agreement.
The study group of 58 children (48 boys and 10 girls; mean age 13.1 ± 2.1 years) included 29 with scaphoid fractures (8 corner, 9 distal pole, 10 waist, and 2 proximal pole) and 29 without fractures. Multiple views had higher sensitivity (3-view, 93.0%; 4-view, 96.5%) for fracture identification when compared to individual views (41.0-89.6%). The oblique view was 100% specific for the identification of a scaphoid fracture, but it lacked sensitivity. The PA scaphoid view had the highest sensitivity (89.6%) and NPV (90%) when compared to other individual views and its inclusion in the 4-view examinations produced the highest inter-rater agreement (93%, κ = 0.86).
Multiple radiographic views of the wrist with the inclusion of a PA scaphoid view (4-view) produced the highest sensitivity, NPV, and inter-rater agreement for the identification of a scaphoid fracture in children.
本研究旨在系统地研究不同影像学视图在儿童舟状骨骨折识别中的表现。
本病例对照研究比较了 2008 年 1 月至 2019 年 7 月期间进行的 4 视图腕关节影像学检查，包括儿童舟状骨骨折组和年龄、性别匹配的无骨折儿童组。随机分组后，每种检查至少相隔 1 周，每次分别使用每种视图，然后使用无（3 视图）和后前位（PA）舟状骨视图（4 视图）的多视图进行 3 次检查，以确定是否存在舟状骨骨折。计算了敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），并进行了组内一致性分析。
研究组包括 58 例儿童（48 例男孩，10 例女孩；平均年龄 13.1 ± 2.1 岁），其中 29 例有舟状骨骨折（8 例角部，9 例远极部，10 例腰部，2 例近极部），29 例无骨折。与单独视图相比，多视图（3 视图，93.0%；4 视图，96.5%）对骨折的识别具有更高的敏感性。斜视图对舟状骨骨折的特异性为 100%，但敏感性较低。与其他单独视图相比，PA 舟状骨视图的敏感性（89.6%）和 NPV（90%）最高，其包含在 4 视图检查中产生了最高的组内一致性（93%，κ=0.86）。
包括 PA 舟状骨视图（4 视图）在内的腕关节多视图检查可提高儿童舟状骨骨折的识别敏感性、NPV 和组内一致性。
