Emergency Radiology最新文献

{"title":"Concurrent emergency head and cervical spine CT utilization: temporal trends, diagnostic yield, and clinical implications.","authors":"Eero Vartiainen, Teemu Luoto, Otso Arponen, Irina Rinta-Kiikka, Jussi Hirvonen","doi":"10.1007/s10140-026-02538-3","DOIUrl":"10.1007/s10140-026-02538-3","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the diagnostic yield, temporal trends, and clinical implications of concurrent non-contrast head and cervical spine computed tomography (CT) in emergency department trauma patients over a 10-year period.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 9,359 consecutive patients who underwent concurrent head and cervical-spine CT for suspected trauma between May 2012 and April 2022. Patient demographics, trauma mechanisms, alcohol documentation, imaging findings, and management of cervical fractures were analyzed. Diagnostic yields were calculated overall and by age, mechanism (with focus on ground-level falls), and time period. Temporal trends and predictors of cervical-spine fracture were assessed using regression models.</p><p><strong>Results: </strong>Acute cervical-spine fractures were present in 4.9% (457/9,359) of patients, while intracranial or craniofacial abnormalities occurred in 23.9% (2,240/9,359). Concurrent abnormalities on both scans were rare (1.3%), with no significant overall association between positive head CT and cervical-spine fracture (OR 1.16, p = 0.174). Imaging volume increased five-fold over the decade, while diagnostic yields declined significantly for both cervical fractures (from 7.1% to 3.9%) and cranial abnormalities (from 28.5% to 22.0%; both p < 0.001). This decline was driven by a rising proportion of ground-level falls (from 47% to 61%), a low-energy mechanism with low yield. Of 457 cervical fractures, 19.9% were treated surgically.</p><p><strong>Conclusions: </strong>Despite a five-fold increase in concurrent head and cervical spine CT utilization, diagnostic yields declined markedly over the 10-year period, primarily driven by the growing dominance of low-energy ground-level falls. These findings highlight significant overutilization of routine concurrent imaging.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"971-979"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First nationwide clinical indication-based diagnostic reference levels incorporating size-specific dose estimates for adult chest CT in Morocco.","authors":"Youssef Madkouri, Hamza Sekkat, Oussama El Mouden, Farida Bentayeb, Youssef El Merabet, Abdellah Khallouqi, Abdellah Halimi, Omar El Rhazouani","doi":"10.1007/s10140-026-02507-w","DOIUrl":"10.1007/s10140-026-02507-w","url":null,"abstract":"<p><strong>Purpose: </strong>To establish nationwide clinical indication-based multicenter diagnostic reference levels (DRLs) for adult chest CT examinations in Morocco.</p><p><strong>Methods: </strong>This retrospective multicenter study included 1,238 adult chest CT examinations grouped into four clinical indications: Lung nodule/follow-up, Infection/ILD/fibrosis, lung cancer staging/lymph node evaluation, and emergency/PE/trauma. For each indication, CTDIvol and dose-length product (DLP) were analyzed. Multicenter DRLs were defined as the 75th percentile of center-level median CTDIvol and DLP values. Differences between indication groups were assessed using the Kruskal-Wallis test, with results reported using medians and 95% confidence intervals.</p><p><strong>Results: </strong>Dose levels differed significantly between clinical indications for both CTDIvol and DLP (p < 0.001). Emergency/PE/trauma examinations showed the highest patient-level dose values, followed by lung cancer staging/lymph node evaluation, infection/ILD/fibrosis, and lung nodule/follow-up. Patient-level P75 values for CTDIvol were 10.11, 7.10, 5.00, and 4.80 mGy, respectively, while corresponding DLP P75 values were 439.78, 339.60, 250.00, and 214.60 mGy·cm.</p><p><strong>Conclusion: </strong>Adult chest CT dose levels vary substantially according to clinical indication. Clinical indication-based multicenter DRLs provide a more appropriate optimization framework than a single anatomy-based chest CT DRL and should be used to guide protocol harmonization and dose optimization in Moroccan CT practice.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1075-1087"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CTA-positive, angiography-negative lower GI bleeding: an institutional imaging-guided management algorithm.","authors":"Elias Lugo-Fagundo, Hajra Ashrad, Carolina Lugo-Fagundo, Connor W Smith, Christos Georgiades, Elliot K Fishman","doi":"10.1007/s10140-026-02514-x","DOIUrl":"10.1007/s10140-026-02514-x","url":null,"abstract":"<p><p>Gastrointestinal bleeding is a common acute presentation in the emergency department (ED) that may require immediate, life-saving intervention. Lower gastrointestinal bleeding (LGIB) represents a frequent source of high-acuity ED presentations, requiring time-sensitive decisions regarding imaging selection, level of care, transfusion strategy, and subspecialty consultation. In such cases, rapid diagnosis and hemodynamic assessment are crucial and facilitated by a multimodal diagnostic approach. Colonoscopy, nuclear medicine studies, and cross-sectional imaging are well-established modalities for evaluating LGIB, with computed tomography angiography (CTA) rapidly emerging as a first-line diagnostic tool, particularly in hemodynamically unstable patients. When active extravasation is identified on CTA, patients are often referred for transcatheter angiography (TA) to enable localization and potential endovascular intervention. However, ambiguity remains regarding the appropriate management of cases in which active hemorrhage is identified on CTA but not reproduced on TA. This discordance may reflect the intermittent nature of hemorrhage, temporal delays between imaging and intervention, or differing detection thresholds across modalities, creating a significant diagnostic and therapeutic dilemma for emergency, gastroenterology, and interventional radiology teams involved in the acute management of LGIB. We propose an institutional, imaging-guided management strategy for patients with CTA-positive but angiography-negative LGIB, emphasizing a tiered approach that prioritizes conservative management with arterial sheath retention, followed by provocative angiography, and selective use of colonoscopy. These strategies are not applied in a rigid or sequential manner but rather represent complementary options that are selectively employed based on hemodynamic status, clinical trajectory, transfusion requirements, and evidence of ongoing or recurrent bleeding.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1219-1232"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric hantavirus in emergency radiology: recognition without overreliance on imaging.","authors":"Weerapong Lilitwat","doi":"10.1007/s10140-026-02535-6","DOIUrl":"10.1007/s10140-026-02535-6","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1267-1268"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agreement between emergency medicine residents and radiologists in RSNA-Based chest CT interpretation.","authors":"Senol Ardic, Recep Dede, Ozgen Gonenc Cekic, Suna Ibrahimoglu, Eser Bulut, Ali Küpeli","doi":"10.1007/s10140-026-02505-y","DOIUrl":"10.1007/s10140-026-02505-y","url":null,"abstract":"<p><strong>Background: </strong>Standardized interpretation of chest computed tomography (CT) is essential for clinical decision-making in patients presenting to the emergency department with suspected coronavirus disease 2019 (COVID-19).</p><p><strong>Objectives: </strong>This study evaluated interobserver agreement between emergency medicine residents (EMRs) and radiologists using the Radiological Society of North America (RSNA) classification and examined the effect of training level.</p><p><strong>Methods: </strong>This retrospective single-center study included 1,104 patients with suspected COVID-19 who underwent chest CT between December 1, 2020, and January 1, 2021. CT findings were classified as typical, indeterminate, atypical, or negative for pneumonia according to RSNA criteria. A total of 23 EMRs independently evaluated 48 CT examinations each. Resident interpretations were compared with routine radiology reports. Interobserver agreement among radiologists was additionally assessed by independent re-evaluation of 100 CT scans. Agreement was measured using Cohen's kappa (κ) coefficient. Diagnostic performance of the typical category was assessed using real time polymerase chain reaction (RT-PCR) as the reference standard.</p><p><strong>Results: </strong>The mean patient age was 59.2 years, and 50.9% were male. RT-PCR positivity was 79.1%. Overall agreement between EMRs and radiologists was good (κ = 0.705; 95% CI, 0.671-0.740; p < 0.001). Agreement was very good for typical (κ = 0.827; 95% CI, 0.793-0.859) and negative (κ = 0.804; 95% CI, 0.765-0.847) categories, but lower for indeterminate (κ = 0.340; 95% CI, 0.253-0.428) and atypical (κ = 0.341; 95% CI, 0.216-0.456) categories. Agreement among radiologists was also good (κ = 0.730; 95% CI, 0.610-0.840; p < 0.001). Agreement improved with increasing training level.</p><p><strong>Conclusion: </strong>RSNA-based chest CT classification shows good overall agreement. Lower agreement in indeterminate and atypical patterns highlights the need for targeted training and closer radiology collaboration.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1109-1116"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penetrating carotid artery injury: CT angiography findings, imaging predictors of hemodynamic instability, and concordance with digital subtraction angiography.","authors":"Leslie Pérez-Castaño, Santiago Quiceno-Ramírez, Valentina Mejía-Quiñones, Laura Parra-Herrera, Laura Gómez-Cely, José J Serna, Alberto F García, Carlos Ordoñez, Edgar Folleco-Pazmiño","doi":"10.1007/s10140-026-02540-9","DOIUrl":"10.1007/s10140-026-02540-9","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the computed tomography angiography (CTA) findings of penetrating carotid artery injury in a high-volume trauma center, to identify imaging manifestations associated with neurological and hemodynamic instability at admission, and to assess the diagnostic concordance between CTA and digital subtraction angiography (DSA).</p><p><strong>Methods: </strong>An observational, cross-sectional study with an analytical component and retrospective data collection was conducted in patients over 18 years of age with penetrating carotid trauma admitted to a tertiary referral center in Cali, Colombia, between January 2012 and December 2022. Imaging findings on CTA were characterized, factors associated with a Glasgow Coma Scale (GCS) ≤ 8 and with systolic blood pressure (SBP) < 90 mmHg at admission were analyzed by logistic regression and bivariate analysis, and the diagnostic concordance between CTA and DSA was assessed using Cohen's kappa.</p><p><strong>Results: </strong>A total of 89 patients were included, with a median age of 33 years (IQR 23-42), of whom 84 (94.4%) were male. CTA was performed in 87 patients and DSA in 51 (49 with complete comparative data). Single lesions predominated (70.1%), zone II was the most frequently affected neck region (51.7%), non-laceration was the most common lesion type (67.8%), and the left side was most involved (55.2%). Dissection involving more than 25% of the lumen was the most prevalent manifestation (26.4%), and the cervical segment of the internal carotid artery was the most affected anatomical area (47.1%). Among the 70 patients with a recorded GCS, 26 (37.1%) had a GCS ≤ 8. Intubation at admission (adjusted OR 14.07, 95% CI 2.33-84.97) and older age (adjusted OR 1.06 per year, 95% CI 1.00-1.11) were independently associated with GCS ≤ 8. Vessel rupture was the strongest imaging predictor of hemodynamic instability (OR 9.02, 95% CI 2.49-32.71). Overall in-hospital mortality was 23.6% (21/89); no imaging-based variable was independently associated with mortality. Diagnostic concordance between CTA and DSA was almost perfect for neck zone (κ = 0.924), laterality (κ = 0.956), and anatomical area (κ = 0.845), but only moderate for lesion manifestation (κ = 0.540).</p><p><strong>Conclusion: </strong>Penetrating carotid trauma predominantly affects young males, with the cervical segment of the internal carotid artery in zone II being the most involved. Intubation at admission and older age were independently associated with severe neurological impairment, while vessel rupture was the strongest imaging predictor of hemodynamic instability. In-hospital mortality (23.6%) was not associated with any specific imaging manifestation. CTA showed almost perfect concordance with DSA for anatomical localization but only moderate agreement for lesion manifestation, supporting its role as a first-line diagnostic tool while highlighting the added value of DSA in selected cases.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1089-1099"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency radiology of severe acute injury in extreme alpine summer sports: a pictorial essay.","authors":"Milena Calabrese, Federica Vaccarino, Rossana Franciosi, Carlo Cosimo Quattrocchi, Marco Parillo","doi":"10.1007/s10140-026-02508-9","DOIUrl":"10.1007/s10140-026-02508-9","url":null,"abstract":"<p><p>Extreme alpine summer sports are increasingly popular and expose participants to high-energy trauma in remote mountain environments. This pictorial essay reviews the emergency radiology of severe acute injuries associated with down-hill mountain biking, rock climbing, paragliding, BASE jumping, canyoning, and rafting, with emphasis on mechanism-based imaging interpretation. Injury patterns differ across disciplines but are largely determined by velocity, fall height, landing posture, impact surface, axial loading, torsional forces, and water-related hazards. Down-hill mountain biking commonly produces extremity, thoracic, craniofacial, abdominal, and spinal injuries after high-speed crashes or handlebar impact. Rock climbing and paragliding frequently involve falls from height and hard landings, leading to thoracolumbar fractures, pelvic trauma, calcaneal or ankle injuries, and, in severe cases, neurologic compromise or visceral injury. BASE jumping is associated with high-velocity landing trauma, particularly involving the lower limbs, pelvis, and spine. Canyoning and rafting combine blunt trauma with environmental risks such as submersion, aspiration, hypothermia, and drowning-related complications. In high-energy trauma or polytrauma, whole-body computed tomography is the cornerstone of emergency assessment, enabling rapid evaluation of head, spine, chest, abdomen, and pelvis. Radiography remains useful for isolated appendicular injuries, whereas magnetic resonance imaging is essential for spinal cord, ligamentous, marrow, and selected soft-tissue injuries. Awareness of sport-specific mechanisms helps radiologists optimize image selection, maintain an appropriate search pattern, recognize injuries that may coexist after axial loading, and communicate urgent findings promptly. A mechanism-oriented approach may improve diagnostic accuracy, guide multidisciplinary management, and reduce missed injuries in patients presenting after alpine summer extreme sports trauma.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1233-1247"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: CT-defined orbital wall burden and early visual dysfunction in acute orbital trauma: A retrospective cohort study.","authors":"Tugay Usta, Osman Faruk Bayramlar, Servet Yüce, Elif Nur Koçak, Türker Demirtakan, Eren Sert, Serkan Doğan, Fatma Esin Özdemir, Ece Yalçındağ, İbrahim Koçak, Hüseyin Bayramlar","doi":"10.1007/s10140-026-02519-6","DOIUrl":"10.1007/s10140-026-02519-6","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"1269"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-derived adrenal-to-spleen ratio as a predictor of massive transfusion and mortality in emergency transcatheter arterial embolization of active bleeding.","authors":"Hans-Jonas Meyer, Felix Pfister, Sebastian Ebel, Holger Gößmann, Matthias Mehdorn, Uwe Scheuermann, Hans-Michael Tautenhahn, Christian Kleber, Timm Denecke, Manuel Florian Struck","doi":"10.1007/s10140-026-02549-0","DOIUrl":"https://doi.org/10.1007/s10140-026-02549-0","url":null,"abstract":"<p><strong>Purpose: </strong>In cases of severe shock, the adrenal gland undergoes hyperperfusion to ensure adequate circulation of stress hormones. Concurrently, the spleen experiences hypoperfusion in order to maintain optimal central blood pressure. The objective of this study was to identify the associations between adrenal and spleen parameters on computed tomography (CT) scans and patient outcomes in individuals with active bleeding who underwent transcatheter arterial embolization (TAE).</p><p><strong>Methods: </strong>A single-center retrospective analysis was conducted on consecutive patients who underwent TAE due to bleeding from various anatomical sites following CT imaging over a five-year period (2018-2022). The initial CT scan for the detection of the bleeding site was used to determine the mean adrenal gland and spleen radiodensities, and the adrenal-to-spleen ratio. The CT-parameters were then incorporated into multivariable logistic regression models to detect associations with the primary outcome of all-cause 30-day mortality and secondary outcome massive transfusion.</p><p><strong>Results: </strong>The study cohort included 126 patients (62.7% male), with a median age of 67.4 years. The 30-day mortality rate was 28.6%, and 24.6% of patients received a massive transfusion. In multivariable analysis, the adrenal-to-spleen ratio was found to be independently associated with 30-day mortality (odds ratio 15.7, 95% confidence interval 2.55-99.09, p = 0.003) and massive transfusion (odds ratio 49.69, 95% confidence interval 6.29-392.30, p < 0.001).</p><p><strong>Conclusion: </strong>The results suggest that the adrenal-to-spleen ratio may be associated with 30-day mortality and the need for massive transfusion in patients undergoing TAE. Further studies with more homogenous patient cohorts and higher sample sizes are needed to confirm these results.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy & clinical importance of AI confidence for extremity fracture detection: 2,508-patient retrospective cohort.","authors":"Sabine Morris Delhez, Thomas Breiner Enøe, Oke Gerke, Bjarke Viberg, Pia Iben Pietersen, Benjamin Schnack Brandt Rasmussen, Janni Jensen","doi":"10.1007/s10140-026-02546-3","DOIUrl":"https://doi.org/10.1007/s10140-026-02546-3","url":null,"abstract":"<p><strong>Purpose: </strong>To estimate diagnostic performance of a deep learning algorithm for extremity fracture detection on radiographs in patients aged ≥ 2 years using a refined reference standard. Secondary, to compare positive predictive value (PPV) by the algorithm's built-in confidence level (high vs. low) and diagnostic performance between adults (≥ 18 years) and children.</p><p><strong>Methods: </strong>This retrospective single-center study consecutively included patients with radiography of a suspected extremity fracture between January and December 2024. The index test was the algorithm output (bounding boxes with confidence). The reference standard was the radiology report with discordant cases adjudicated by follow-up imaging when available or specialist review. Sensitivity, specificity, PPV and negative predictive value (NPV) were calculated with 95% confidence intervals; differences were tested using the McNemar and a score test and patient-clustered logistic regression.</p><p><strong>Results: </strong>There were 2,508 patients, median age 34 years (range 2-105), 1,236 males; 815 patients had a total of 1,028 fractures. Per-fracture sensitivity and PPV were 92.7% (95% CI: 90.9-94.5) and 87.6% (95% CI: 85.5-89.7); Specificity and NPV were 94.4% (95% CI: 93.2-95.4) and 96.6% (95% CI: 95.6-97.4). PPV for high-confidence was superior to low-confidence detections (99.1% vs 59.1%, p < 0.001). Children had higher per-fracture PPV than adults (91.7% vs. 86.1%; p= 0.01), with no significant difference in per-fracture sensitivity, or case-wise performance.</p><p><strong>Conclusion: </strong>The algorithm showed good diagnostic performance for extremity fracture detection on radiographs. The AI's confidence stratification strongly influenced PPV, and higher PPV was seen among children.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}