Abstract
Background
Elbow injuries and fractures are a common pathology in the pediatric emergency unit. X-ray and CT scan of the elbow are the standard diagnostic procedures, which increase exposure to radiation in children. Previous studies have shown that fractures can also be visualized by ultrasound (US); thus, this study aimed to evaluate the diagnostic accuracy of elbow US compared with radiography for the diagnosis of elbow fracture in children.
Materials and methods
This was a prospective observational study of patients aged 2–14 years that presented to emergency departments with a suspected elbow fracture requiring radiographic evaluation. Elbow US for diagnosing elevated posterior fat pad or lipohemarthrosis was performed. All patients underwent elbow radiography and received clinical follow-up. Initial or follow-up X-ray or CT scan was used as the reference standard for fracture diagnosis.
Results
Seventy-five patients with a mean age of 6.51 ± 3.68 years were enrolled in the study. Twenty-eight (37.3%) patients had positive results for fracture.
The sensitivity, specificity, and accuracy of US in the diagnosis of elbow fractures were 92.9% (95% CI 76.5–99.1%), 89.4% (95% CI 76.9–96.5%) and 90.7% (95% CI 81.7–96.2%). In patients with fracture, US demonstrated a lipohaemarthrosis in 20 patients (71.4%), elevated posterior fat pad in 19 patients (67.9%), cortical disruption in 10 patients (35.7%), and effusion in three patients (10.7%).
Conclusion
Our results showed high diagnostic accuracy for the ultrasonography diagnosis of an elbow fracture, which allows us to confirm ultrasonography imaging of the elbow as a safe alternative in the primary evaluation of pediatric elbow injuries.
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Abbreviations
- CT:
-
Computed tomographic
- ED:
-
Emergency department
- LR−:
-
Likelihood ratio of a negative test
- LR+:
-
Likelihood ratio of a positive test
- NPV:
-
Negative predictive value
- PFP:
-
Posterior fat pad
- PPV:
-
Positive predictive value
- US:
-
Ultrasound
References
Merckaert S. Epidemiology of pediatric upper extremity fractures in tertiary care center in Switzerland. PediatrEmerg Care. 2020. https://doi.org/10.1097/PEC.0000000000002047.
Bachman D, Santora S. Musculoskeletal trauma. In: Fleisher GR, Ludwig S, editors. Textbook of pediatric emergency medicine. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. p. 1335–75.
Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW. Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. Ann Emerg Med. 2013;61(1):9–17.
Eckert K, Ackermann O, Janssen N, Schweiger B, Radeloff E, Liedgens P. Accuracy of the sonographic fat pad sign for primary screening of pediatric elbow fractures: a preliminary study. J Med Ultrason. 2014;41(4):473–80.
Burnier M, Buisson G, Ricard A, Cunin V, Pracros JP, Chotel F. Diagnostic value of ultrasonography in elbow trauma in children: prospective study of 34 cases. OrthopTraumatolSurg Res. 2016;102(7):839–43.
Lee SH, Yun SJ. Diagnostic performance of ultrasonography for detection of pediatric elbow fracture: a meta-analysis. Ann Emerg Med. 2019;74(4):493–502.
Avcı M, Kozacı N, Beydilli İ, Yılmaz F, Eden AO, Turhan S. The comparison of bedside point-of-care ultrasound and computed tomography in elbow injuries. Am J Emerg Med. 2016;34(11):2186–90.
Tsou PY, Ma YK, Wang YH, Gillon JT, Rafael J, Deanehan JK. Diagnostic accuracy of ultrasound for upper extremity fractures in children: a systematic review and meta-analysis. Am J Emerg Med. 2020. https://doi.org/10.1016/j.ajem.2020.04.071.
Tokarski J, Avner JR, Rabiner JE. Reduction of radiography with point-of-care elbow ultrasonography for elbow trauma in children. J Pediatr. 2018;198:214–9.
Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41(8):862–8.
Zuazo I, Bonnefoy O, Tauzin C, Borocco A, Lippa A, Legrand M, Chateil JF. Acute elbow trauma in children: role of ultrasonography. PediatrRadiol. 2008;38(9):982–8.
Heydari F, SamsamShariat S, Majidinejad S, Masoumi B. The use of ultrasonography for the confirmation of pulled elbow treatment. J EmergPract Trauma. 2018;4(1):24–8.
Tsung JW, Blaivas M. Rapid screening for the posterior fat pad sign in suspected pediatric elbow fractures using point-of-care ultrasound: a “FAST exam” for the traumatized elbow. Crit Ultrasound J. 2010;1(3):111–6.
Eckert K, Janssen N, Ackermann O, Schweiger B, Radeloff E, Liedgens P. Ultrasound diagnosis of supracondylar fractures in children. Eur J Trauma EmergSurg. 2014;40(2):159–68.
Hamer DD, Blanker MH, Edens MA, Buijteweg LN, Boomsma MF, van Helden SH, Mauritz GJ. Ultrasound for distal forearm fracture: a systematic review and diagnostic meta-analysis. PLoS ONE. 2016;11(5):1–6.
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Isfahan University of Medical Sciences.
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Azizkhani, R., Hosseini Yazdi, Z. & Heydari, F. Diagnostic accuracy of ultrasonography for diagnosis of elbow fractures in children. Eur J Trauma Emerg Surg 48, 3777–3784 (2022). https://doi.org/10.1007/s00068-021-01648-6
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DOI: https://doi.org/10.1007/s00068-021-01648-6