Department of Pediatric Surgery, University of Technology Dresden, Dresden, Saxony, Germany.
Faculty of Medicine Carl Gustav Carus, Institute for Medical Informatics and Biometry (IMB), University of Technology Dresden, Dresden, Saxony, Germany.
BMC Med Imaging. 2024 Sep 27;24(1):255. doi: 10.1186/s12880-024-01433-y.
Several studies have advocated the use of ultrasound to diagnose distal forearm fractures in children. However, there is limited data on the diagnostic accuracy of ultrasound for distal forearm fractures when conducted by pediatric surgeons or trainees who manage orthopedic injuries in children. The objective of this study was to determine the diagnostic accuracy of point-of-care ultrasound (POCUS) for pediatric distal forearm fractures when conducted by pediatric surgeons and trainees after minimal training.
This diagnostic study was conducted in a tertiary hospital emergency department in Germany. Participants were children and adolescents under 15 years of age who presented to the emergency department with an acute, suspected, isolated distal forearm fracture requiring imaging. Pediatric surgeons and trainees, after minimal training for sonographic fracture diagnosis, performed 6-view distal forearm POCUS on each participant prior to X-ray imaging. All data was retrospectively collected from the hospital's routine digital patient files. The primary outcome was the diagnostic accuracy of POCUS compared to X-ray as the reference standard.
From February to June 2021, 146 children under 15 met all inclusion and exclusion criteria, and 106 data sets were available for analysis. Regarding the presence of a fracture, X-ray and Wrist-POCUS showed the same result in 99.1%, with 83/106 (78.3%) fractures detected in both modalities and one suspected buckle fracture on POCUS not confirmed in the radiographs. Wrist-POCUS had a sensitivity of 100% (95% CI [0.956, 1]) and a specificity of 95.8% (95% CI [0.789, 0.999]) compared to radiographs. In 6 cases, there were minor differences regarding a concomitant ulnar buckle. The amount of prior ultrasound training had no influence on the accuracy of Wrist-POCUS for diagnosing distal forearm fractures. All fractures were reliably diagnosed even when captured POCUS images did not meet all quality criteria.
Pediatric surgeons and trainees, after minimal training in POCUS, had excellent diagnostic accuracy for distal forearm fractures in children and adolescents using POCUS compared to X-ray.
多项研究主张使用超声诊断儿童前臂远端骨折。然而,在管理儿童骨科损伤的小儿外科医生或受训者进行超声检查时,关于超声诊断前臂远端骨折的准确性的数据有限。本研究的目的是确定经过最少培训后,小儿外科医生和受训者进行即时护理超声(POCUS)诊断儿童前臂远端骨折的准确性。
这是一项在德国一家三级医院急诊科进行的诊断性研究。参与者为年龄在 15 岁以下的儿童和青少年,他们因急性疑似孤立性前臂远端骨折就诊,需要影像学检查。在进行超声骨折诊断的最少培训后,小儿外科医生和受训者对每位参与者进行了 6 个视图的前臂远端 POCUS,然后进行 X 射线成像。所有数据均从医院的常规数字患者档案中回顾性收集。主要结局是将 POCUS 与 X 射线作为参考标准的诊断准确性进行比较。
2021 年 2 月至 6 月,共有 146 名 15 岁以下的儿童符合所有纳入和排除标准,其中 106 份数据集可用于分析。关于骨折的存在,X 射线和腕部 POCUS 的结果相同,99.1%(95%CI[0.956,1]),83/106(78.3%)例骨折在两种方法中均被检出,而 POCUS 上怀疑的扣带骨折在 X 射线片中未被证实。与 X 射线相比,腕部 POCUS 的敏感性为 100%(95%CI[0.956,1]),特异性为 95.8%(95%CI[0.789,0.999])。在 6 例中,存在轻微的尺骨扣带伴发差异。先前接受超声培训的次数对 POCUS 诊断前臂远端骨折的准确性没有影响。即使采集的 POCUS 图像未满足所有质量标准,所有骨折仍能得到可靠诊断。
在接受 POCUS 最少培训后,小儿外科医生和受训者使用 POCUS 诊断儿童和青少年前臂远端骨折的准确性很高,与 X 射线相比。