Alexander Sasha Dubrovsky1, Anna Kempinska2, Ilana Bank3, Elise Mok4. 1. Division of Pediatric Emergency Medicine, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Electronic address: sasha.dubrovsky@mcgill.ca. 2. Division of Pediatric Emergency Medicine, Hospital for Sick Children and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Division of Pediatric Emergency Medicine, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Medical Education and Arnold and Blema Steinberg Simulation Centre, McGill University, Montreal, Quebec, Canada. 4. Clinical Research Centre, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada.
Abstract
STUDY OBJECTIVE: The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluoroscopy in determining successful realignment of pediatric forearm fractures. The secondary objective is to determine the rate of agreement of ultrasonography and fluoroscopy in real-time by the treating physician. METHODS: A cross-sectional study was conducted in children younger than 18 years and presenting to an academic emergency department with forearm fractures requiring realignment of a single bone. Physicians performed closed reductions with ultrasonographic assessment of realignment until the best possible reduction was achieved. Fluoroscopy was then immediately performed and images were saved. A positive test result was defined as an inadequately reduced fracture on fluoroscopy by a blinded pediatric orthopedic surgeon (reference standard) and on ultrasonography (index test) and fluoroscopy in real-time by the treating physician. RESULTS: One hundred patients were enrolled (median age 12.1 years; 74% male patients); the radius was involved in 98%, with 27% involving the growth plate. The sensitivity, specificity, positive predictive value, and negative predictive value were 50% (95% confidence interval [CI] 15.4% to 84.6%), 89.1% (95% CI 82.8% to 95.5%), 28.6% (95% CI 4.9% to 52.2%), and 95.3% (95% CI 90.9% to 99.8%), respectively. The treating physicians' agreement rate of the real-time images was 98%. CONCLUSION: Point-of-care ultrasonography can help emergency physicians determine when pediatric forearm fractures have been adequately realigned, but inadequate reductions should be confirmed by other imaging modalities.
STUDY OBJECTIVE: The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluoroscopy in determining successful realignment of pediatric forearm fractures. The secondary objective is to determine the rate of agreement of ultrasonography and fluoroscopy in real-time by the treating physician. METHODS: A cross-sectional study was conducted in children younger than 18 years and presenting to an academic emergency department with forearm fractures requiring realignment of a single bone. Physicians performed closed reductions with ultrasonographic assessment of realignment until the best possible reduction was achieved. Fluoroscopy was then immediately performed and images were saved. A positive test result was defined as an inadequately reduced fracture on fluoroscopy by a blinded pediatric orthopedic surgeon (reference standard) and on ultrasonography (index test) and fluoroscopy in real-time by the treating physician. RESULTS: One hundred patients were enrolled (median age 12.1 years; 74% male patients); the radius was involved in 98%, with 27% involving the growth plate. The sensitivity, specificity, positive predictive value, and negative predictive value were 50% (95% confidence interval [CI] 15.4% to 84.6%), 89.1% (95% CI 82.8% to 95.5%), 28.6% (95% CI 4.9% to 52.2%), and 95.3% (95% CI 90.9% to 99.8%), respectively. The treating physicians' agreement rate of the real-time images was 98%. CONCLUSION: Point-of-care ultrasonography can help emergency physicians determine when pediatric forearm fractures have been adequately realigned, but inadequate reductions should be confirmed by other imaging modalities.
Authors: Jennifer R Marin; Alyssa M Abo; Alexander C Arroyo; Stephanie J Doniger; Jason W Fischer; Rachel Rempell; Brandi Gary; James F Holmes; David O Kessler; Samuel H F Lam; Marla C Levine; Jason A Levy; Alice Murray; Lorraine Ng; Vicki E Noble; Daniela Ramirez-Schrempp; David C Riley; Turandot Saul; Vaishali Shah; Adam B Sivitz; Ee Tein Tay; David Teng; Lindsey Chaudoin; James W Tsung; Rebecca L Vieira; Yaffa M Vitberg; Resa E Lewiss Journal: Crit Ultrasound J Date: 2016-11-03
Authors: Djoke Douma-den Hamer; Marco H Blanker; Mireille A Edens; Lonneke N Buijteweg; Martijn F Boomsma; Sven H van Helden; Gert-Jan Mauritz Journal: PLoS One Date: 2016-05-19 Impact factor: 3.240
Authors: Teri Ann Reynolds; Stas Amato; Irene Kulola; Chuan-Jay Jeffrey Chen; Juma Mfinanga; Hendry Robert Sawe Journal: PLoS One Date: 2018-04-25 Impact factor: 3.240