Diagnostic Accuracy of Point-of-Care Ultrasound for Acute Pediatric Ankle Injuries.

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Pediatric emergency care Pub Date : 2025-07-09 DOI:10.1097/PEC.0000000000003439

Kathleen M Smith, Elise Zimmerman, Zola Trotter, Shannon Wai

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引用次数: 0

Abstract

Objectives: The aim of this study was to determine test performance characteristics of point-of-care ultrasound (POCUS) in the diagnosis of pediatric ankle fractures compared with ankle x-rays. Secondary objectives were to determine if POCUS can reduce the number of x-rays, analyze diagnostic errors, compare the Ottawa Ankle Rules (OAR) with POCUS, and determine if the outcome of the ultrasound results is affected by the musculoskeletal ultrasound experience of the pediatric emergency physicians.

Methods: This was a prospective study of children aged 6 to 18 years who presented to the emergency department with ankle injuries with no prior x-rays. The physicians received a 2-hour training session, performed an ultrasound with a standardized protocol, and documented the POCUS results as positive or negative for fracture. The reference standard was the radiologist's x-ray interpretation.

Results: We enrolled 118 patients with a median age of 12 years (interquartile range, 10 to 14 years). There were 17 fractures among 15 patients; 8 were clinically significant. Overall, POCUS would reduce x-rays by 105 (89%), but miss 6 fractures, including 1 clinically significant fracture. For detecting all ankle fractures, POCUS yielded a sensitivity of 60% (95% CI, 32.3-83.7), a specificity of 96% (95% CI, 90.4-98.9), a positive predictive value of 69.2 (95% CI, 44.2-86.5), and a negative predictive value of 94.3 (95% CI, 89.9-96.9). For the detection of clinically significant fractures, POCUS yielded a sensitivity of 87.5% (95% CI, 47.4-99.7), a specificity of 94.6% (95% CI, 88.5-97.9), a positive predictive value of 53.9 (95% CI, 33.9-72.6), and a negative predictive value of 99.1 (95% CI, 94.3-99.9). The sensitivity of POCUS + OAR and OAR alone was 90% (95% CI, 55.5-99.8), but the specificity was 0% (95% CI not computed).

Conclusions: POCUS alone or combined with OAR is an inadequate screening tool to detect pediatric ankle fractures.

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急诊超声诊断小儿急性踝关节损伤的准确性。

目的：本研究的目的是确定点护理超声（POCUS）在诊断儿童踝关节骨折中的测试性能特征，并与踝关节x射线进行比较。次要目的是确定POCUS是否可以减少x射线的数量，分析诊断错误，比较渥太华踝关节规则（OAR）和POCUS，并确定超声结果的结果是否受到儿科急诊医生肌肉骨骼超声经验的影响。方法：这是一项前瞻性研究，研究对象为6至18岁的儿童，他们因踝关节损伤而就诊于急诊室，之前没有x光检查。医生接受了2小时的培训，按照标准方案进行超声检查，并记录POCUS结果为骨折阳性或阴性。参考标准是放射科医生的x线解读。结果：我们纳入了118例患者，中位年龄为12岁（四分位数范围为10至14岁）。15例患者骨折17例；8例有临床意义。总体而言，POCUS将减少105例x线检查（89%），但遗漏6例骨折，包括1例临床显著骨折。对于所有踝关节骨折的检测，POCUS的敏感性为60% (95% CI, 32.3-83.7)，特异性为96% (95% CI, 90.4-98.9)，阳性预测值为69.2 (95% CI, 44.2-86.5)，阴性预测值为94.3 （95% CI, 89.9-96.9）。对于临床意义骨折的检测，POCUS的敏感性为87.5% (95% CI, 47.4-99.7)，特异性为94.6% (95% CI, 88.5-97.9)，阳性预测值为53.9 (95% CI, 33.9-72.6)，阴性预测值为99.1 （95% CI, 94.3-99.9）。POCUS + OAR和单独OAR的敏感性为90% (95% CI, 55.5-99.8)，但特异性为0% （95% CI未计算）。结论：POCUS单独或联合OAR是不充分的筛查工具，以发现儿童踝关节骨折。

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

Pediatric emergency care 医学-急救医学

CiteScore

2.40

自引率

14.30%

发文量

577

审稿时长

3-6 weeks

期刊介绍： Pediatric Emergency Care®, features clinically relevant original articles with an EM perspective on the care of acutely ill or injured children and adolescents. The journal is aimed at both the pediatrician who wants to know more about treating and being compensated for minor emergency cases and the emergency physicians who must treat children or adolescents in more than one case in there.