ED point-of-care ultrasound in the diagnosis of ankle fractures in children

BackgroundBlunt head trauma is a common presentation to emergency departments (EDs). Identifying skull fractures in children is important as they are known factor of risk for traumatic brain injury (TBI). Currently, CT is the reference standard for diagnosing skull fractures and TBIs in children. Identifying skull fractures with point-of-care ultrasound (POCUS) may help risk-stratify children for TBI following blunt trauma. The purpose of this study is to evaluate the sensitivity, specificity, positive predictive value and negative predictive value of POCUS in identifying skull fractures in children.MethodsA systematic search was performed on 17 July 2020 in Ovid Medline, Cochrane Library, Google Scholar, Web of Science and Embase. Prospective studies reporting skull fractures diagnosed with ultrasound in children younger than 18 years due to blunt head injury were included. Studies that did not confirm the fracture with CT were excluded. The quality of studies was evaluated using the QUADAS-2 tool. Data were extracted from the eligible studies to calculate outcomes such as sensitivity and specificity; when possible overall outcomes were calculated.ResultsSeven studies were included. All eligible studies included patients for whom the decision to perform a CT scan was made in advance. Overall, the included studies demonstrated low risk of bias or had minor concerns regarding risk of bias. The pooled data (n=925) demonstrated a sensitivity of 91%, specificity of 96%, positive predictive value of 88% and negative predictive value of 97%.ConclusionThe included studies demonstrate minor methodological limitations. Overall, the evidence suggests that POCUS is a valid option for diagnosing skull fractures in children visiting the ED after blunt head injury.

Download Full-text

Point-of-Care Ultrasound for the Diagnosis of Skull Fractures in Children Younger Than Two Years of Age

The Journal of Pediatrics ◽

10.1016/j.jpeds.2017.12.057 ◽

2018 ◽

Vol 196 ◽

pp. 230-236.e2 ◽

Cited By ~ 5

Author(s):

Niccolò Parri ◽

Bradley J. Crosby ◽

Lisa Mills ◽

Zachary Soucy ◽

Anna Maria Musolino ◽

...

Keyword(s):

Point Of Care ◽

Point Of Care Ultrasound ◽

Skull Fractures ◽

Fractures In Children

Download Full-text

Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

CJEM ◽

10.1017/cem.2016.397 ◽

2016 ◽

Vol 19 (2) ◽

pp. 131-142 ◽

Cited By ~ 16

Author(s):

Lucas B. Chartier ◽

Laura Bosco ◽

Lauren Lapointe-Shaw ◽

Jordan Chenkin

Keyword(s):

Diagnostic Accuracy ◽

Bone Fractures ◽

Point Of Care ◽

Positive Likelihood Ratio ◽

Ankle Fractures ◽

Long Bone ◽

Point Of Care Ultrasound ◽

Fracture Rate ◽

Test Characteristics ◽

Long Bone Fractures

AbstractObjectivesLong bone fractures (LBFs) are among the most frequent traumatic injuries seen in emergency departments. Reduction and immobilization is the most common form of treatment for displaced fractures. Point-of-care ultrasound (PoCUS) is a promising technique for diagnosing LBFs and assessing the success of reduction attempts. This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs.Data sourceMEDLINE and EMBASE databases were searched through July 19, 2015.Study selectionWe included prospective studies that assessed test characteristics of PoCUS in 1) the diagnosis or 2) the reduction of LBFs. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.Data extractionThirty studies met inclusion criteria (n=3,506; overall fracture rate 48.0%). Test characteristics of PoCUS for the diagnosis of LBFs were as follows: sensitivity 64.7%–100%, specificity 79.2%–100%, positive likelihood ratio (LR) 3.11–infinity, and negative LR zero–0.45. Sensitivity and specificity for the adequate reduction of LBFs with PoCUS were 94%–100% and 56%–100%, respectively. PoCUS diagnosis of pediatric forearm fractures in 10 studies showed a pooled sensitivity of 93.1% (95% confidence interval [CI], 87.2%–96.4%) and specificity of 92.9% (95% CI, 86.6%–96.4%), and PoCUS diagnosis of adult ankle fractures in four studies showed a pooled sensitivity of 89.5% (95% CI, 77.0%–95.6%) and specificity of 94.2% (95% CI, 86.1%–97.7%).ConclusionPoCUS demonstrates good diagnostic accuracy in all LBFs studied, especially in pooled results of diagnosis of pediatric forearm and adult ankle fractures. PoCUS is an appropriate adjunct to plain radiographs for LBFs.

Download Full-text