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


OBJECTIVE
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.


CONCLUSIONS
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.
Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Rachel
R
Rowlands
Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia.
James
J
Rippey
Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia; Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia.
Sing
S
Tie
Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia.
James
J
Flynn
D000058:Accidental Falls; D000293:Adolescent; D001315:Australia; D002648:Child; D002675:Child, Preschool; D005260:Female; D005542:Forearm / Q000502:physiology; D005543:Forearm Injuries / Q000175:diagnosis; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D059408:Pain Management / Q000379:methods; D019095:Point-of-Care Systems / Q000592:standards / Q000639:trends; D011446:Prospective Studies; D014463:Ultrasonography / Q000592:standards*; D014965:X-Rays
emergency physician; pediatric forearm fractures; ultrasound; x-ray study