title: Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes.
abstract: Distal forearm fractures are the most common fracture type in children. Point-of-care-ultrasound (POCUS) is increasingly being used, and preliminary studies suggest that it offers an accurate approach to diagnosis. However, outcomes such as pain, satisfaction, and procedure duration have not been explored but may be salient to the widespread acceptance of this technology by caregivers and children. Our objectives were to examine the test performance characteristics of POCUS for nonangulated distal forearm injuries in children and compare POCUS to x-ray with respect to pain, caregiver satisfaction, and procedure duration.
  
  
  
  We conducted a cross-sectional study involving children aged 4-17 years with a suspected nonangulated distal forearm fracture. Participants underwent both x-ray and POCUS assessment. The primary outcome was sensitivity between POCUS and x-ray, the reference standard. Secondary outcomes included self-reported pain using the Faces Pain Scale-Revised, caregiver satisfaction using a five-item Likert scale, and procedure duration.
  
  
  
  POCUS was performed in 169 children of whom 76 were diagnosed with a fracture including 61 buckle fractures. Sensitivity of POCUS for distal forearm fractures was 94.7% (95% confidence interval [CI] = 89.7-99.8) and specificity was 93.5% (95% CI = 88.6-98.5). POCUS was associated with a significantly lower median (interquartile range [IQR]) pain score compared to x-ray: 1 (0-2) versus 2 (1-3), respectively (median difference = 0.5; 95% CI = 0.5-1; p < 0.001) and no significant difference in median (IQR) caregiver satisfaction score: 5 (0) versus 5 (4-5), respectively (median difference = 0, 95% CI = 0, p = 1.0). POCUS was associated with a significantly lower median (IQR) procedure duration versus x-ray: 1.5 (0.8-2.2) minutes versus 27 (15-58) minutes, respectively (median difference = 34.1, 95% CI = 26.8-41.5, p < 0.001).
  
  
  
  Our findings suggest that POCUS assessment of distal forearm injuries in children is accurate, timely, and associated with low levels of pain and high caregiver satisfaction.
authors.affiliation: Department of Pediatrics, Western University, London, Ontario.|Division of Emergency Medicine, Western University, London, Ontario.|Children's Health Research Institute, London Health Sciences Centre, London, Ontario.
authors.forename: Naveen
authors.initials: N
authors.lastname: Poonai
authors.affiliation: Division of Emergency Medicine, Western University, London, Ontario.
authors.forename: Frank
authors.initials: F
authors.lastname: Myslik
authors.affiliation: Department of Pediatrics, Western University, London, Ontario.|Division of Emergency Medicine, Western University, London, Ontario.
authors.forename: Gary
authors.initials: G
authors.lastname: Joubert
authors.affiliation: Department of Pediatrics, Western University, London, Ontario.
authors.forename: Josiah
authors.initials: J
authors.lastname: Fan
authors.affiliation: Department of Pediatrics, Western University, London, Ontario.|Division of Emergency Medicine, Western University, London, Ontario.
authors.forename: Amita
authors.initials: A
authors.lastname: Misir
authors.affiliation: Department of Pediatrics, Western University, London, Ontario.|Division of Emergency Medicine, Western University, London, Ontario.
authors.forename: Victor
authors.initials: V
authors.lastname: Istasy
authors.affiliation: Division of Emergency Medicine, Western University, London, Ontario.
authors.forename: Melanie
authors.initials: M
authors.lastname: Columbus
authors.affiliation: Division of Emergency Medicine, Western University, London, Ontario.
authors.forename: Robert
authors.initials: R
authors.lastname: Soegtrop
authors.affiliation: Division of Emergency Medicine, Western University, London, Ontario.
authors.forename: Alex
authors.initials: A
authors.lastname: Goldfarb
authors.affiliation: Division of Emergency Medicine, Western University, London, Ontario.
authors.forename: Drew
authors.initials: D
authors.lastname: Thompson
authors.affiliation: Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Alexander Sasha
authors.initials: AS
authors.lastname: Dubrovsky
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D019095:Point-of-Care Systems; D011885:Radius Fractures / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014458:Ulna Fractures / Q000000981:diagnostic imaging*; D014463:Ultrasonography