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

SONOSIM SUMMARY: This prospective study aims to determine if physicians with limited previous ultrasound (US) experience could, following completion of a brief training program, reliably rule out forearm fractures in children. Results showed that pediatric emergency physicians could use US to evaluate for pediatric forearm fractures with high sensitivity and specificity, and that any pain or discomfort associated with US was comparable to pain levels reported during x-ray. The study concludes that physicians with minimal US training are able to diagnose fractured forearms in children with a high degree of accuracy, and that US may be preferable to x-ray study for patients and parents.

Rowlands R, Rippey J, Tie S, et al. Bedside ultrasound vs x-ray for the diagnosis of forearm fractures in children. J Emerg Med. 2017 Feb;52(2):208-215.

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.

To read the article, visit the Journal of Emergency Medicine.

SonoSim Keywords: Forearm Fracture Ultrasound, Forearm Ultrasound, Bedside Ultrasound