title: An Algorithmic Approach Using Ultrasonography in the Diagnosis of Pediatric Nasal Bone Fracture.
abstract: BACKGROUND
  Ultrasonography (US) was recently reported as a reliable modality for diagnosing nasal bone fractures. However, whether US is reliable as a screening tool in the pediatric emergency department (ED) remains unknown. This prospective cohort study had a 2-fold aim: to assess the utility of US in the diagnosis of pediatric nasal bone fracture, and to evaluate the validity of our protocol for managing pediatric nasal bone fractures (Fuchu-Kids algorithm).
  
  
  METHODS
  Among the patients who presented at the ED with facial trauma, those with a suspected nasal bone fracture were enrolled in the study. Patients were treated according to Fuchu-Kids algorithm, and the validity of the protocol using US imaging was evaluated.
  
  
  RESULTS
  Among 81 patients who were enrolled during the 1-year study period, 63 patients were able to complete the process described in our protocol for further examination. The diagnostic power of the Fuchu-Kids algorithm had a sensitivity of 91.7%, a specificity of 92.3%, a positive predictive value (PPV) of 88%, and a negative predictive value (NPV) of 94.7%. However, when the performance of US was assessed as a single examination, its sensitivity, specificity, PPV, and NPV were 75%, 92.3%, 85.7%, and 85.7%, respectively.
  
  
  CONCLUSIONS
  Using our algorithm, the majority of patients with nasal bone fracture were successfully diagnosed and screened out successfully. Repeated US imaging is effective when clinical symptoms persist even if the first US imaging was negative for nasal bone fracture. However, a detailed medical interview and clinical examination are mandatory, regardless of the use of US.
authors.affiliation: *Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Children's Medical Center †Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
authors.forename: Ikkei
authors.initials: I
authors.lastname: Tamada
authors.forename: Takaaki
authors.initials: T
authors.lastname: Mori
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Inoue
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Shido
authors.forename: Marie
authors.initials: M
authors.lastname: Aoki
authors.forename: Yukie
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Ruri
authors.initials: R
authors.lastname: Kamogawa
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009295:Nasal Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012887:Skull Fractures / Q000175:diagnosis*; D015599:Trauma Severity Indices; D014463:Ultrasonography / Q000379:methods*