AI Article Synopsis
- The study aimed to see if elbow ultrasound (US) could reduce the need for X-rays in patients with elbow trauma by evaluating its effectiveness alongside history and physical exams.
- In a trial with 100 pediatric patients, 23 were determined to not need radiography after being assessed with elbow US, which showed a high sensitivity of 100% for detecting fractures in cases of low suspicion.
- The findings suggest that using elbow US can lead to shorter emergency department stays and decrease reliance on X-rays in appropriately selected patients.
Article Abstract
Objectives: To determine whether point-of-care elbow ultrasound (US), with history and physical examination, can decrease radiography for patients with elbow trauma. Secondary outcomes included evaluation of pediatric emergency department (PED) length of stay (LOS) and test performance characteristics.
Study Design: This was a prospective study of patients up to age 21 years with elbow trauma necessitating radiography. After clinical examination and before radiography, pediatric emergency physicians performed elbow ultrasonography of the posterior fat pad and determined whether radiography was required. All patients underwent elbow radiography and received clinical follow-up. Times for US and radiography were recorded.
Results: A total of 100 patients with a mean age of 7.9 years were enrolled, 42 of whom had a fracture. In 23 patients, the physician determined that radiography could be eliminated. Elbow US combined with clinical suspicion for fracture had a sensitivity of 100% (95% CI, 92%-100%). Elbow US took a median of 3 minutes (IQR, 2-5 minutes), and completion and interpretation of elbow radiography took a median of 60 minutes (IQR, 43-84 minutes). The overall sensitivity of elbow US was 88% (95% CI, 75%-96%).
Conclusions: Elbow US has a high sensitivity to rule out fracture and is best used in patients with a low clinical suspicion of fracture. The use of conventional radiography and PED LOS may be reduced in patients with a low clinical concern for fracture and normal elbow US.
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| http://dx.doi.org/10.1016/j.jpeds.2018.02.072 | DOI Listing |
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