title: Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department.
abstract: OBJECTIVE
  Ultrasound (US) may be a useful tool for rapidly diagnosing fractures. Our objective was to determine the accuracy of US as compared with radiographs in the detection of nonangulated distal forearm fractures.
  
  
  METHODS
  Distal forearm US was performed and interpreted at the bedside by a pediatric emergency medicine physician before radiography in a prospective sample of children with possible nonangulated distal forearm fractures. A second pediatric emergency medicine physician with extensive US experience gave a final interpretation of the images. This second reviewer was blinded to both clinical and radiographic findings. The primary outcome was accuracy in the detection of fracture via the blinded reviewer's US interpretation when compared with the radiologist's clinical radiography results. Patient-reported FACES pain scores (range, 0-5) associated with both US and radiography were compared.
  
  
  RESULTS
  Of 101 enrolled patients, 46 had a fracture detected by the radiologist. When compared with radiographs, the blinded US interpretation had an overall accuracy of 94% (95% confidence interval [CI], 88%-99%). Sensitivity and specificity were 96% (95% CI, 85%-99%) and 93% (95% CI, 82%-98%), respectively. Positive predictive value was 92%, and negative predictive value was 96%. Mean FACES pain scores were higher following radiography than US (1.7 vs 1.2, respectively; P = 0.004).
  
  
  CONCLUSIONS
  For the diagnosis of nonangulated distal forearm fractures in children, bedside US holds promise as a diagnostic modality, particularly with appropriate training. Ultrasound is at least no more painful that traditional radiographs. Pediatric emergency medicine physicians should consider becoming proficient in this application.
authors: Palmer Children's Hospital, Orlando, FL, USA.
authors: Frances M
authors: FM
authors: Chaar-Alvarez
authors: Fred
authors: F
authors: Warkentine
authors: Keith
authors: K
authors: Cross
authors: Sandra
authors: S
authors: Herr
authors: Ronald I
authors: RI
authors: Paul
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D010147:Pain Measurement; D019095:Point-of-Care Systems / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013997:Time Factors; D014458:Ulna Fractures / Q000000981:diagnostic imaging*; D014463:Ultrasonography