Extremity Fracture Diagnosis Using Bedside Ultrasound in Pediatric Trauma Patients Referring to Emergency Department; A Diagnostic Study


1 Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

2 Department of Emergency Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

3 Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

4 Postdoctoral research fellow, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

5 Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.


This study performed to assess the efficacy of ultrasound in screening upper and lower extremities fractures in comparison with standard X-ray in pediatric trauma patients.
Materials and Methods
This was a prospective diagnostic study conducted at the emergency department of Imam Khomeini Complex Hospital, Tehran, Iran. All patients with the age under 18-year-old admitted with limb trauma were first evaluated by attending emergency medicine physician using ultrasound and then underwent necessary X-rays. Thereafter, the ultrasound reports were compared with X-ray reports regarding measurement of its accuracy.
Forty patients with the mean age of 9.47 ± 5.26 years (minimum of 2 and a maximum of 17 years) entered the study (75% were male). The average time of performing ultrasound in pediatric population is 3.99± 0.83 minutes which is statistically significant compared to X-ray, 16.12 ± 4.15 minutes (P<0.001). The overall sensitivity, specificity and accuracy of ultrasound in detecting fractures in evaluated pediatrics were 100%, 100% and 100%, respectively. The results showed an almost perfect agreement between ultrasound and X ray for detecting upper and lower extremity fractures in pediatrics population (k=1.00).
It is likely that ultrasound could be an accurate and time saving substitute for X-ray in screening for limb fractures in pediatric trauma patients admitted in emergency department.