title: Bedside ultrasound in the diagnosis of pediatric clavicle fractures.
abstract: OBJECTIVE
  The objective of the study was to determine the diagnostic accuracy of pediatric emergency physicians in diagnosing clavicle fractures by bedside ultrasound (US).
  
  
  METHODS
  This was a prospective study of pediatric emergency department (ED) patients with suspected clavicle fractures conducted in a tertiary-care, freestanding pediatric hospital. A convenience sample of patients younger than 17 years underwent bedside US for detection of clavicle fracture by pediatric emergency physicians with limited US training. Ultrasound findings were compared with standard radiographs, which were considered the criterion standard. Pain scores using the validated color analog scale (0-10) were determined before and during US. Total length of stay in the ED, time to US, and time to radiograph were recorded.
  
  
  RESULTS
  Fifty-eight patients were enrolled, of which 39 (67%) had fracture determined by radiograph. Ultrasound interpretation gave a sensitivity of 89.7% (95% confidence interval [CI], 75.8%-97.1%) and specificity of 89.5% (95% CI, 66.9%-98.7%). Positive and negative predictive values were 94.6% (95% CI, 81.8%-99.3%) and 81.0% (95% CI, 58.1%-94.5%), respectively. Positive and negative likelihood ratios were 8.33 and 0.11, respectively. Pain scores averaged 4.7 before US and 5.2 during US (P = 0.204). There was a statistically significant difference between mean time to US (76 minutes) and mean time to radiograph (107 minutes) (P < 0.001).
  
  
  CONCLUSIONS
  Pediatric emergency physicians with minimal formal training can accurately diagnose clavicle fractures by US. In addition, US itself is not associated with an increase in pain and may reduce length of stay in the ED.
authors: Division of Pediatric Emergency Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ 85016, USA. mingtchien@yahoo.com
authors: Ming
authors: M
authors: Chien
authors: Blake
authors: B
authors: Bulloch
authors: Pamela
authors: P
authors: Garcia-Filion
authors: Mostafa
authors: M
authors: Youssfi
authors: Michael W
authors: MW
authors: Shrader
authors: Lee S
authors: LS
authors: Segal
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002968:Clavicle / Q000000981:diagnostic imaging* / Q000293:injuries*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015588:Observer Variation; D010147:Pain Measurement; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D013383:Suburban Population; D013997:Time Factors; D014463:Ultrasonography; D014505:Urban Population