School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia.
Ann Emerg Med. 2024 Mar;83(3):198-207. doi: 10.1016/j.annemergmed.2023.10.008. Epub 2023 Nov 22.
In patients aged 5 to 15 years with a clinically nondeformed distal forearm injury presenting to the emergency department (ED), we examined whether point-of-care ultrasound or radiographic imaging had better diagnostic accuracy, with the reference diagnosis determined by an expert panel review.
This multicenter, open-label, diagnostic randomized controlled trial was conducted in South East Queensland, Australia. Eligible patients were randomized to receive initial imaging through point-of-care ultrasound performed by an ED clinician or radiograph. Images were defined as "no," "buckle," or "other" fracture by the treating clinician. The primary outcome was the diagnostic accuracy of the treating clinician's interpretation compared against the reference standard diagnosis, which was determined retrospectively by an expert panel consisting of an emergency physician, pediatric radiologist, and pediatric orthopedic surgeon, who reviewed all imaging and follow-up.
Two-hundred and seventy participants were enrolled, with 135 randomized to each initial imaging modality. There were 132 (97.8%) and 112 (83.0%) correctly diagnosed participants by ED clinicians in the point-of-care ultrasound and radiograph groups, respectively (absolute difference [AD]=14.8%; 95% confidence interval [CI] 8.0% to 21.6%; P<.001). Point-of-care ultrasound had better accuracy for participants with "buckle" fractures (AD=18.5%; 95% CI 7.1% to 29.8%) and "other" fractures (AD=17.1%; 95% CI 2.7% to 31.6%). No clinically important fractures were missed in either group.
In children and adolescents presenting to the ED with a clinically nondeformed distal forearm injury, clinician-performed (acquired and interpreted) point-of-care ultrasound more accurately identified the correct diagnosis than clinician-interpreted radiographic imaging.
在因临床无明显变形的前臂远端损伤而到急诊科就诊的 5 至 15 岁患者中，我们通过专家小组评估参考诊断来检验即时护理超声或放射成像在诊断准确性方面的优劣。
本多中心、开放标签、诊断性随机对照试验在澳大利亚昆士兰州东南部进行。符合条件的患者被随机分配到急诊科医生进行即时护理超声或放射成像初始检查。治疗医生通过即时护理超声检查对图像进行“无”、“扣带”或“其他”骨折的定义。主要结局是根据专家小组的参考标准诊断，评估治疗医生解释与参考诊断的诊断准确性，专家小组由一名急诊医师、小儿放射科医师和小儿矫形外科医师组成，他们回顾了所有影像学检查和随访资料。
共纳入 270 名参与者，其中 135 名参与者被随机分配至初始影像学检查。在即时护理超声和放射组中，分别有 132 名（97.8%）和 112 名（83.0%）参与者得到正确诊断（绝对差异[AD]=14.8%；95%置信区间[CI]8.0%至 21.6%；P<.001）。即时护理超声在“扣带”骨折（AD=18.5%；95%CI 7.1%至 29.8%）和“其他”骨折（AD=17.1%；95%CI 2.7%至 31.6%）患者的诊断准确性更高。两组均未漏诊有临床意义的骨折。
在因临床无明显变形的前臂远端损伤而到急诊科就诊的儿童和青少年中，医生进行（获取和解释）即时护理超声的诊断准确性高于医生解释的放射成像。
