Kolja Eckert1, Ole Ackermann2, Niklas Janssen3, Bernd Schweiger4, Elke Radeloff3, Peter Liedgens3. 1. Department for Pediatric Surgery, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany. eckert.kolja@me.com. 2. Department for Orthopaedics, Trauma- and Reconstructive Surgery, Evangelic Hospital Oberhausen, Virchowstrasse 20, 46047, Oberhausen, Germany. 3. Department for Pediatric Surgery, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany. 4. Department for Diagnostical und Interventional Radiology and Neuroradiology, Universitary Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
Abstract
PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of the sonographic fat pad sign (FPS) as a predictor for pediatric elbow fractures. PATIENTS AND METHODS: This is a prospective study of children under 14 years with suspected elbow fractures. All participants underwent at first ultrasonography focused on a FPS followed by standard elbow radiographs. US findings were compared to final fracture diagnosis. RESULTS: 38 out of 79 children had an elbow fracture. A sonographic FPS predicted an elbow fracture with a sensitivity/specificity of 97.3/90.5 %, positive/negative likelihood ratios (LR) were 10.2/0.03 and correct/false classification rates were 93.7/6.3 %. Primary US findings were later reviewed by a blinded physician giving a congruity of 96.2 %. These secondary US findings predicted an elbow fracture with a sensitivity/specificity of 92.1/92.7 %, positive/negative LRs were 12.6/0.09 and correct/false classification rates were 92.4/7.5 %. CONCLUSION: The sonographic FPS could serve as a useful screening tool in primary evaluation of pediatric elbow injuries. If a fracture is unlikely after clinical and US evaluation, additional radiographs are dispensable, thereby potentially minimizing the radiation burden in childhood and reducing the length of stay in the Emergency Department.
PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of the sonographic fat pad sign (FPS) as a predictor for pediatric elbow fractures. PATIENTS AND METHODS: This is a prospective study of children under 14 years with suspected elbow fractures. All participants underwent at first ultrasonography focused on a FPS followed by standard elbow radiographs. US findings were compared to final fracture diagnosis. RESULTS: 38 out of 79 children had an elbow fracture. A sonographic FPS predicted an elbow fracture with a sensitivity/specificity of 97.3/90.5 %, positive/negative likelihood ratios (LR) were 10.2/0.03 and correct/false classification rates were 93.7/6.3 %. Primary US findings were later reviewed by a blinded physician giving a congruity of 96.2 %. These secondary US findings predicted an elbow fracture with a sensitivity/specificity of 92.1/92.7 %, positive/negative LRs were 12.6/0.09 and correct/false classification rates were 92.4/7.5 %. CONCLUSION: The sonographic FPS could serve as a useful screening tool in primary evaluation of pediatric elbow injuries. If a fracture is unlikely after clinical and US evaluation, additional radiographs are dispensable, thereby potentially minimizing the radiation burden in childhood and reducing the length of stay in the Emergency Department.
Entities:
Keywords:
Children; Elbow; Fat pad sign; Fracture; Ultrasound
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