A meta-analysis on the diagnostic utility of ultrasound in pediatric distal forearm fractures

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Abstract

Pediatric distal forearm fractures, comprising 30% of musculoskeletal injuries in children, are conventionally diagnosed using radiography. Ultrasound has emerged as a safer diagnostic tool, eliminating ionizing radiation, enabling bedside examinations with real-time imaging, and proving effective in non-hospital settings. The objective of this study is to evaluate the diagnostic efficacy of ultrasound for detecting distal forearm fractures in the pediatric population. A systematic review and meta-analysis were conducted through a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases until October 1, 2023, following established guidelines. Eligible studies, reporting diagnostic accuracy measures of ultrasound in pediatric patients with distal forearm fractures, were included. Relevant data elements were extracted, and data analysis was performed. The analysis included 14 studies with 1377 patients, revealing pooled sensitivity and specificity of 94.5 (95% CI 92.7–95.9) and 93.5 (95% CI 89.6–96.0), respectively. Considering pre-test probabilities of 25%, 50%, and 75% for pediatric distal forearm fractures, positive post-test probabilities were 83%, 44%, and 98%, while negative post-test probabilities were 2%, 6%, and 15%, respectively. The bivariate model indicated significantly higher diagnostic accuracy in the subgroup with trained ultrasound performers vs. untrained performers ( p = 0.03). Furthermore, diagnostic accuracy was significantly higher in the subgroup examining radius fractures vs. ulna fractures ( p < 0.001), while no significant differences were observed between 4-view and 6-view ultrasound subgroups or between radiologist ultrasound interpreters and non-radiologist interpreters. This study highlighted ultrasound’s reliability in detecting pediatric distal forearm fractures, emphasizing the crucial role of expertise in precisely confirming fractures through ultrasound examinations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10140-024-02208-2.

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Author and article information

Contributors

Ali Gholamrezanezhad:

ORCID: http://orcid.org/0000-0001-6930-4246

Ali.Gholamrezanezhad@med.usc.edu

Journal

Journal ID (nlm-ta): Emerg Radiol

Journal ID (iso-abbrev): Emerg Radiol

Title: Emergency Radiology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1070-3004

ISSN (Electronic): 1438-1435

Publication date (Electronic): 5 February 2024

Publication date PMC-release: 5 February 2024

Publication date (Print): 2024

Volume: 31

Issue: 2

Pages: 213-228

Affiliations

[1 ]Department of Radiology, Keck School of Medicine, University of Southern California (USC), ( https://ror.org/03taz7m60) 1441 Eastlake Ave Ste 2315, Los Angeles, CA 90089 USA

[2 ]Department of Radiology, Mayo Clinic, ( https://ror.org/02qp3tb03) Rochester, MN USA

[3 ]School of Medicine, Tehran University of Medical Sciences, ( https://ror.org/01c4pz451) Tehran, Iran

[4 ]School of Medicine, Shahid Beheshti University of Medical Sciences, ( https://ror.org/034m2b326) Tehran, Iran

[5 ]GRID grid.67105.35, ISNI 0000 0001 2164 3847, Department of Radiology, , University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, ; Cleveland, OH USA

[6 ]Department of Diagnostic and Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, ( https://ror.org/03gds6c39) Houston, TX USA

Author information

Ali Gholamrezanezhad http://orcid.org/0000-0001-6930-4246

Article

Publisher ID: 2208

DOI: 10.1007/s10140-024-02208-2

PMC ID: 10994871

PubMed ID: 38311698

SO-VID: be88e62f-0ade-4aa9-9c98-21d567c49099

License:

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