Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children

Joni E. Rabiner, Hnin Khine, Jeffrey R. Avner, Lana M. Friedman, James W. Tsung

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Study objective: We determine the test performance characteristics for point-of-care ultrasonography performed by pediatric emergency physicians compared with radiographic diagnosis of elbow fractures and compare interobserver agreement between enrolling physicians and an experienced pediatric emergency medicine sonologist. Methods: This was a prospective study of children aged up to 21 years and presenting to the emergency department (ED) with elbow injuries requiring radiographs. Before obtaining radiographs, pediatric emergency physicians performed focused elbow ultrasonography. An ultrasonographic result positive for fracture at the elbow was defined as the pediatric emergency physician's determination of an elevated posterior fat pad or lipohemarthrosis of the posterior fat pad. All patients received an elbow radiograph in the ED and clinical follow-up. The criterion standard for fracture was fracture on initial or follow-up radiographs. Results: One hundred thirty patients with a mean age of 7.5 years were enrolled by 26 sonologists. Forty-three (33%) patients had a radiograph result positive for fracture. A positive elbow ultrasonographic result had a sensitivity of 98% (95% confidence interval [CI] 88% to 100%), specificity of 70% (95% CI 60% to 79%), positive likelihood ratio of 3.3 (95% CI 2.4 to 4.5), and negative likelihood ratio of 0.03 (95% CI 0.01 to 0.23) for fracture. The interobserver agreement (κ) was 0.77. The use of elbow ultrasonography would reduce radiographs in 48% of patients but would miss 1 fracture. Conclusion: Point-of-care ultrasonography is highly sensitive for elbow fractures, and a negative ultrasonographic result may reduce the need for radiographs in children with elbow injuries. Elbow ultrasonography may be useful in settings in which radiography is not readily accessible or is time consuming to obtain.

Original languageEnglish (US)
Pages (from-to)9-17
Number of pages9
JournalAnnals of Emergency Medicine
Volume61
Issue number1
DOIs
StatePublished - Jan 2013

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Point-of-Care Systems
Elbow
Ultrasonography
Confidence Intervals
Physicians
Emergencies
Pediatrics
Adipose Tissue
Hospital Emergency Service
Wounds and Injuries
Radiography

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. / Rabiner, Joni E.; Khine, Hnin; Avner, Jeffrey R.; Friedman, Lana M.; Tsung, James W.

In: Annals of Emergency Medicine, Vol. 61, No. 1, 01.2013, p. 9-17.

Research output: Contribution to journalArticle

Rabiner, Joni E. ; Khine, Hnin ; Avner, Jeffrey R. ; Friedman, Lana M. ; Tsung, James W. / Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. In: Annals of Emergency Medicine. 2013 ; Vol. 61, No. 1. pp. 9-17.
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abstract = "Study objective: We determine the test performance characteristics for point-of-care ultrasonography performed by pediatric emergency physicians compared with radiographic diagnosis of elbow fractures and compare interobserver agreement between enrolling physicians and an experienced pediatric emergency medicine sonologist. Methods: This was a prospective study of children aged up to 21 years and presenting to the emergency department (ED) with elbow injuries requiring radiographs. Before obtaining radiographs, pediatric emergency physicians performed focused elbow ultrasonography. An ultrasonographic result positive for fracture at the elbow was defined as the pediatric emergency physician's determination of an elevated posterior fat pad or lipohemarthrosis of the posterior fat pad. All patients received an elbow radiograph in the ED and clinical follow-up. The criterion standard for fracture was fracture on initial or follow-up radiographs. Results: One hundred thirty patients with a mean age of 7.5 years were enrolled by 26 sonologists. Forty-three (33{\%}) patients had a radiograph result positive for fracture. A positive elbow ultrasonographic result had a sensitivity of 98{\%} (95{\%} confidence interval [CI] 88{\%} to 100{\%}), specificity of 70{\%} (95{\%} CI 60{\%} to 79{\%}), positive likelihood ratio of 3.3 (95{\%} CI 2.4 to 4.5), and negative likelihood ratio of 0.03 (95{\%} CI 0.01 to 0.23) for fracture. The interobserver agreement (κ) was 0.77. The use of elbow ultrasonography would reduce radiographs in 48{\%} of patients but would miss 1 fracture. Conclusion: Point-of-care ultrasonography is highly sensitive for elbow fractures, and a negative ultrasonographic result may reduce the need for radiographs in children with elbow injuries. Elbow ultrasonography may be useful in settings in which radiography is not readily accessible or is time consuming to obtain.",
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