POCUS up to the task of finding, ruling out pediatric forearm fractures

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Emergency physicians armed with point-of-care ultrasound (POCUS) may have all they need to diagnose children with suspected fractures of the distal forearm.

So found pediatric emergency-med researchers at Basurto University Hospital in Bilbao, Spain. Their study posted online Oct. 13 in the European Journal of Emergency Medicine.

Frédéric Samson, MD, PhD, and colleagues prospectively diagnosed 115 patients under 15 years old (mean, 9.1) who presented in their ER with injuries of the distal forearm.

The children were imaged with both POCUS and x-ray, then evaluated by a pediatric trauma specialist with blinding of one test to the other. The x-ray served as the reference.

The researchers found a total of 72 fractures in 57 patients, 15 of whom had complex combined fractures of the radius and ulna.

The sensitivity and specificity of POCUS came in at 94.4 percent and 96.8 percent, respectively, while the positive and negative predictive values were, respectively, 93.2 percent and 97.5 percent.

POCUS, which has the increasingly important advantage of saving children from receiving a dose of ionizing radiation, “enables the clinical diagnosis of distal forearm fractures in ED,” the authors conclude. “In addition, this is a highly accurate technique that can be applied easily by the ED pediatrician. As such, its inclusion as part of the physical examination could improve the accuracy of the clinical diagnosis and the global management of the patient.”