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Bedside Ultrasound vs X-Ray for the Diagnosis of Forearm Fractures in Children

  • Rachel Rowlands
    Affiliations
    Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia

    University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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  • James Rippey
    Affiliations
    Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia

    School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia
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  • Sing Tie
    Affiliations
    Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia

    Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
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  • James Flynn
    Correspondence
    Reprint Address: James Flynn, mbbs, facem, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia 6008, Australia
    Affiliations
    Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia

    School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia

    School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia
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Published:November 01, 2016DOI:https://doi.org/10.1016/j.jemermed.2016.10.013

      Abstract

      Background

      Painful forearm injuries after a fall occur frequently in children. X-ray study is currently the gold standard investigation. Ultrasound (US) is a potential alternative that avoids exposure to ionizing radiation and may be less painful than x-ray study; and familiarity and skill with US is increasing among emergency physicians.

      Objectives

      The primary aim of this study was to determine if a cohort of physicians with little or no previous experience with US could, after a short training program, safely exclude forearm fractures in children. Secondary aims were to compare any pain or discomfort associated with clinical examination, US, and x-ray study and to determine the acceptability of US as a diagnostic tool to parents and patients.

      Methods

      A prospective, nonrandomized, interventional diagnostic study was performed on children between the ages of 0 and 16 years who had a suspected fracture of the forearm. US scanning was performed by a group of physicians, most with little or no previous US experience.

      Results

      After the brief training program, a group of pediatric emergency physicians could diagnose forearm fractures in children with a sensitivity of 91.5% and a specificity of 87.6%. Pain associated with US was no better or worse than pain associated with x-ray study. Patients and parents preferred US over x-ray study as an investigation modality for suspected forearm fractures.

      Conclusion

      A group of pediatric emergency physicians with limited previous experience could, after a short training program, diagnose forearm fractures in children. Pain associated with US was no better or worse than pain associated with x-ray study.

      Keywords

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