What is the utility of point-of-care ultrasound for suspected pulled elbow? A single-centre case series.

IF 1.6 4区 医学 Q2 PEDIATRICS
David J McCreary, Nikhil Tambe, Niall Mullen
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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.

护理点超声波对疑似肘关节牵拉有什么作用?单中心病例系列。
桡骨头脱位,又称牵拉肘或护士肘,是儿科急诊室(PED)的常见病。50%的患儿是在未经目击的情况下受伤或病史不典型。此外,在患儿情绪不安或受到惊吓时,检查可能会比较困难,这意味着受伤的确切位置并不总是很容易辨认。许多儿童在不必要的情况下接受了上肢X光检查,还有一些儿童在怀疑肘关节牵拉的情况下接受了试图复位的手术,而骨折才是他们疼痛的原因:评估护理点超声(POCUS)正确识别疑似肘关节牵拉病例的能力:回顾性分析 2020 年 11 月至 2022 年 11 月期间在本地区大型综合医院 PED 就诊的 0-5 岁患者。我们查阅了分诊类别为 "肘部损伤 "的所有患者的电子病历。我们排除了有明显畸形、明显肿胀、道路交通碰撞或其他重大创伤病史(如高处坠落)的患者。POCUS由作者根据已有的临床方案进行:结果:37 名患者接受了 POCUS 检查。结果:37 名患者接受了 POCUS 检查,其中 29 人有典型病史,所有患者的肘关节牵拉 POCUS 检查结果均为阳性。在其余 8 位病史不典型的患者中,有 3 位与未受影响的肘部相比,POCUS 呈阳性。五名病史不典型的患者的 POCUS 结果为阴性,经进一步评估后被诊断为软组织损伤。所有 32 例声学征象阳性的患者最终诊断为肘关节牵拉,这意味着特异性为 100%(47.8-100)(P = 0.00003)。灵敏度为 100%:结论:在这项回顾性研究中,经过适当培训的临床医生使用 POCUS 作为临床检查的延伸,可以可靠地确诊肘关节牵拉。这有可能减少不必要的辐射,并缩短患儿及其护理人员在急诊科的就诊时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
5.90%
发文量
487
审稿时长
3-6 weeks
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.
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