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Bedside ultrasonography in the emergency room can reliably diagnose clavicle fractures in children with no more discomfort than x-rays -- and no radiation. Dr. Keith P. Cross at the University of Louisville, Kentucky, and colleagues report that finding in Academic Emergency Medicine for July. They note that kids often have clavicle fractures, which usually require imaging confirmation. "However, radiographs take time, cost money, and expose patients to radiation."

To test the accuracy of bedside ultrasound as an alternative, the researchers prospectively studied a convenience sample of 100 children with shoulder injuries requiring x-rays. A standardized ultrasound exam of the clavicle was performed, starting at the sternal junction and moving laterally, and then x-rays were taken.

X-rays showed clavicle fractures in 43 children, and 96% of the ultrasound studies were congruent. Overall, ultrasonography was 95% sensitive and 96% specific, with positive and negative predictive values of 95% and 96%, respectively.

There were two false-negative ultrasound exams, both hairline fractures faintly visible on x-rays.

After the examinations, 86 children who were at least 5 years old were asked to rate pain on a 0-5 "faces" pain scale (with 0 meaning "no hurt"). The interpolated median scores were 0.6 for ultrasound and 0.8 for radiographs.

Dr. Cross and colleagues conclude, "Given its diagnostic accuracy, minimal pain during examination, and lack of ionizing radiation, physicians should consider ultrasound for bedside diagnosis of pediatric clavicle fractures."

Source: Reuters Health