{"title":"What is the utility of point-of-care ultrasound for suspected pulled elbow? A single-centre case series.","authors":"David J McCreary, Nikhil Tambe, Niall Mullen","doi":"10.1111/jpc.16659","DOIUrl":null,"url":null,"abstract":"<p><p>Radial head subluxation, known as pulled elbow or nursemaid's elbow, is a common presentation to the Paediatric Emergency Department (PED). Fifty per cent of children present following an unwitnessed injury or with an atypical history. Furthermore, examination can be difficult in an upset or frightened child meaning the precise location of the injury is not always easily identifiable. Many children receive upper limb x-rays unnecessarily and others undergo attempted reduction for suspected pulled elbow when a fracture is the cause of their pain.</p><p><strong>Objective: </strong>To evaluate the ability of point-of-care ultrasound (POCUS) to correctly identify cases of suspected pulled elbow.</p><p><strong>Methods: </strong>A retrospective review of patients aged 0-5 years presenting to the PED of our large District General Hospital from November 2020 to November 2022. We reviewed the electronic medical records of all patients presenting with a triage category of 'elbow Injury'. We excluded patients presenting with obvious deformity, significant swelling and history of road traffic collision or other major trauma mechanism such as a fall from a height. POCUS was carried out by the authors according to pre-existing clinical protocols.</p><p><strong>Results: </strong>Thirty-seven patients underwent POCUS. Twenty-nine had a typical history and all had a positive POCUS for pulled elbow. Of the remaining eight patients with an atypical history, three were found to have a positive POCUS compared to unaffected elbow. Five patients with an atypical history had negative POCUS findings and were diagnosed as soft tissue injuries after further assessment. All 32 with positive sonographic signs had a final diagnosis of pulled elbow, meaning the specificity was 100% (47.8-100) (P = 0.00003). The sensitivity was 100%.</p><p><strong>Conclusion: </strong>Use of POCUS by appropriately trained clinicians, as an extension of a clinical examination, in this retrospective study reliably confirmed pulled elbow. This has the potential to reduce both unnecessary radiation as well as the time in the emergency department for the child and their carers.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of paediatrics and child health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/jpc.16659","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Radial head subluxation, known as pulled elbow or nursemaid's elbow, is a common presentation to the Paediatric Emergency Department (PED). Fifty per cent of children present following an unwitnessed injury or with an atypical history. Furthermore, examination can be difficult in an upset or frightened child meaning the precise location of the injury is not always easily identifiable. Many children receive upper limb x-rays unnecessarily and others undergo attempted reduction for suspected pulled elbow when a fracture is the cause of their pain.
Objective: To evaluate the ability of point-of-care ultrasound (POCUS) to correctly identify cases of suspected pulled elbow.
Methods: A retrospective review of patients aged 0-5 years presenting to the PED of our large District General Hospital from November 2020 to November 2022. We reviewed the electronic medical records of all patients presenting with a triage category of 'elbow Injury'. We excluded patients presenting with obvious deformity, significant swelling and history of road traffic collision or other major trauma mechanism such as a fall from a height. POCUS was carried out by the authors according to pre-existing clinical protocols.
Results: Thirty-seven patients underwent POCUS. Twenty-nine had a typical history and all had a positive POCUS for pulled elbow. Of the remaining eight patients with an atypical history, three were found to have a positive POCUS compared to unaffected elbow. Five patients with an atypical history had negative POCUS findings and were diagnosed as soft tissue injuries after further assessment. All 32 with positive sonographic signs had a final diagnosis of pulled elbow, meaning the specificity was 100% (47.8-100) (P = 0.00003). The sensitivity was 100%.
Conclusion: Use of POCUS by appropriately trained clinicians, as an extension of a clinical examination, in this retrospective study reliably confirmed pulled elbow. This has the potential to reduce both unnecessary radiation as well as the time in the emergency department for the child and their carers.
期刊介绍:
The Journal of Paediatrics and Child Health publishes original research articles of scientific excellence in paediatrics and child health. Research Articles, Case Reports and Letters to the Editor are published, together with invited Reviews, Annotations, Editorial Comments and manuscripts of educational interest.