ArticleJSES international2025
Utility of point-of-care ultrasound for the diagnosis of elbow fractures in the pediatric emergency department.
Article in JSES international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pediatric elbow injuries are a common pathology in the emergency department. Radiographic imaging is the reference test for diagnosing elbow fractures. However, ultrasonography is an imaging method with growing importance that has shown to be useful in musculoskeletal pathology. The aim of this study was to evaluate the precision of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians compared with radiography for the detection of elbow fractures in pediatric patients, and to compare the interobserver concordance between the performer and an independent evaluator with wide experience in POCUS. Methods and settings: This was a prospective, observational cohort study including pediatric patients under 14 years that visited the emergency department with elbow injuries and required radiographs. Before obtaining the radiographic image, an elbow ultrasonography was performed and interpreted as positive for fracture if an elevated posterior fat pad or lipohemearthrosis was detected. All patients got an elbow radiograph and clinical follow-up. Results: One hundred and six patients were selected, from which 91 patients were electable for the study with a mean of age of 7.8 years. Twenty eight patients of the total (30.8%) had fracture. A sensitivity for POCUS positive result of 96.4% was obtained (95% confidence interval [CI] 81.7%-99.9%), with a specificity of 84.1% (95% CI 72.7%-92.1%). The positive predictive value was 74% (95% CI 61.6-83.4) and the negative predictive value 98.1% (95% CI 88.0-99.7). The POCUS took 14.2 (standard deviation 5.2) seconds to be performed. The interobserver concordance was almost perfect (ĸ = 0.89). Conclusion: Elbow POCUS is a useful tool for the diagnosis of elbow fracture with a high sensitivity and negative predictive value and a very good interobserver concordance. It may be a useful safe alternative to optimize the evaluation and diagnosis of elbow trauma.
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