Background: In the previous 2 decades, ultrasound (US) has been used to aide in the diagnosis of soft tissue injuries. Only recently have medical providers found point-of-care ultrasound (POCUS) useful in identifying bone fractures due to its hyperresonance on imaging. This critically appraised topic compares the sensitivity, specificity, radiation exposure, time to diagnosis and length of hospital stay in diagnosing clavicular fractures in the pediatric population.
Methods: An exhaustive literature search was performed in June 2019 using the following search engines: MEDLINE-PubMed, Clinical Key, Cochrane and Google Scholar. A risk of bias was performed on the included studies.
Results: Initial search rendered 12 articles, where 2 total articles met eligibility criteria and are included in this critically appraised topic. The two included studies demonstrate high levels of sensitivity and specificity in diagnosing pediatric clavicular fractures using POCUS vs plain radiography while providing less pain and length of stay in the emergency department (ED). The first study compared POCUS and plain radiography in a tertiary pediatric ED and provided a sensitivity and specificity of 95% (CI 83%-99%) and 96% (CI 87%-99%), respectively. The second study compared POCUS and plain radiography in a stand-alone pediatric ED resulting in sensitivity and specificity of 89.7% (CI 75.8%-97.1%) and 89.5% (CI 66.9%-98.7%), respectively. Additionally, both studies showed decreased time to diagnosis, decreased time spent in the ED and less reported pain with POCUS vs plain radiography.
Conclusion: This critically appraised topic provides evidence supporting the use of POCUS in the pediatric population and can accurately diagnose clavicular fractures in the pediatric population when compared to plain radiography. However, articles presented in this review show moderate risk of bias. Regardless, with decreased radiation exposure, coupled with decreased pain scores and time spent in the ED, POCUS should be considered more often in the diagnosis of clavicular fractures in the pediatric population.
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