Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound
Abstract Background In children, non-fractured wrists generally need no treatment and those that are fractured may only require a 3-week cast without any clinical follow-up. The ability to perform a point-of-care triage decision if radiographs are needed could improve patient flow and decrease unnec...
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doaj-26d4c4ed8a424d9a8e28275f0a8d4b382020-11-25T01:46:29ZengSpringerOpenCritical Ultrasound Journal2036-31762036-79022017-05-01911810.1186/s13089-017-0066-zMinimal training sufficient to diagnose pediatric wrist fractures with ultrasoundHenrik Hedelin0Christian Tingström1Hanna Hebelka2Jon Karlsson3Department of Orthopedics, Sahlgrenska University Hospital, Instititute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgDepartment of Orthopedics, Sahlgrenska University Hospital, Instititute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgDepartment of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgDepartment of Orthopedics, Sahlgrenska University Hospital, Instititute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgAbstract Background In children, non-fractured wrists generally need no treatment and those that are fractured may only require a 3-week cast without any clinical follow-up. The ability to perform a point-of-care triage decision if radiographs are needed could improve patient flow and decrease unnecessary radiographs. The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training. Methods Physicians with no previous US experience attended a 1.5 h course in the use of US to diagnose distal radius fractures at the Emergency Department (ED). The physicians firstly used US to diagnose a potential fracture and, if the patient had a fracture, grouped the patient according to how they wanted him/her to be treated based on US. The physician then interpreted the subsequent radiographs and decided on a treatment based on this information. Consultant traumatologists and a senior radiologist established a gold standard for correct treatment and radiological diagnosis, respectively. Results One hundred and sixteen injuries in 115 patients were included. The ED physician identified 75 fractures on radiographs. With the exception of a minimal buckle fracture, all were identified on US. US had a tendency to interpret complete fractures on radiographs as incomplete (n = 7) leading to incorrect treatment decisions. Conclusions In the hands of an US novice, US examination is comparable with radiographs as a point-of-care tool to distinguish a fractured wrist from a non-fractured one. US is not, however, as good as radiographs for placing fractured wrists into the correct treatment group. Level of Evidence Level III. Diagnostic study of non-consecutive patients.http://link.springer.com/article/10.1186/s13089-017-0066-zUltrasoundPediatricFractureEmergencyWrist |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Henrik Hedelin Christian Tingström Hanna Hebelka Jon Karlsson |
spellingShingle |
Henrik Hedelin Christian Tingström Hanna Hebelka Jon Karlsson Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound Critical Ultrasound Journal Ultrasound Pediatric Fracture Emergency Wrist |
author_facet |
Henrik Hedelin Christian Tingström Hanna Hebelka Jon Karlsson |
author_sort |
Henrik Hedelin |
title |
Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound |
title_short |
Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound |
title_full |
Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound |
title_fullStr |
Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound |
title_full_unstemmed |
Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound |
title_sort |
minimal training sufficient to diagnose pediatric wrist fractures with ultrasound |
publisher |
SpringerOpen |
series |
Critical Ultrasound Journal |
issn |
2036-3176 2036-7902 |
publishDate |
2017-05-01 |
description |
Abstract Background In children, non-fractured wrists generally need no treatment and those that are fractured may only require a 3-week cast without any clinical follow-up. The ability to perform a point-of-care triage decision if radiographs are needed could improve patient flow and decrease unnecessary radiographs. The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training. Methods Physicians with no previous US experience attended a 1.5 h course in the use of US to diagnose distal radius fractures at the Emergency Department (ED). The physicians firstly used US to diagnose a potential fracture and, if the patient had a fracture, grouped the patient according to how they wanted him/her to be treated based on US. The physician then interpreted the subsequent radiographs and decided on a treatment based on this information. Consultant traumatologists and a senior radiologist established a gold standard for correct treatment and radiological diagnosis, respectively. Results One hundred and sixteen injuries in 115 patients were included. The ED physician identified 75 fractures on radiographs. With the exception of a minimal buckle fracture, all were identified on US. US had a tendency to interpret complete fractures on radiographs as incomplete (n = 7) leading to incorrect treatment decisions. Conclusions In the hands of an US novice, US examination is comparable with radiographs as a point-of-care tool to distinguish a fractured wrist from a non-fractured one. US is not, however, as good as radiographs for placing fractured wrists into the correct treatment group. Level of Evidence Level III. Diagnostic study of non-consecutive patients. |
topic |
Ultrasound Pediatric Fracture Emergency Wrist |
url |
http://link.springer.com/article/10.1186/s13089-017-0066-z |
work_keys_str_mv |
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1725019183623700480 |