22: Ultrasound-Guided Reductions of Distal Forearm Fractures in Children
Notice bibliographique
Résumé
Reduction of forearm fractures in children is frequently performed with the aid of fluoroscopy. Point-of-care ultrasound has emerged as a tool clinicians can use to diagnose and treat fractures; advantages include no radiation, real-time high quality images, availability in most emergency departments and no need for specialized personnel. The objective of this study is to determine how ultrasound compares to fluoroscopy in assessing the adequacy of reduction of single-bone distal forearm fractures in pediatrics. We completed a prospective observational study in a tertiary-care pediatric emergency department. Eligible patients were <18 years of age with acute (<72 h) single-bone fractures of the mid or distal forearm that required reduction. Exclusion criteria included fractures with displacement of the radius and ulna, intra-articular fractures, open fractures or any neurovascular compromise. A one-hour simulation-based session was given to novice-ultrasound emergency physicians who then performed the reduction under ultrasound guidance (high frequency linear probe) until they felt they had the best possible reduction and saved images in at least two-planes. Based on the saved images, the physician recorded whether the reduction was adequate or if further reduction was necessary. Fluoroscopy was then performed and the physician assessed the fluoroscopic images to decide whether the fracture had been adequately reduced; management continued based on the fluoroscopic images. Results were defined dichotomously as “adequately” or “inadequately” reduced for all images. To date, 96 patients were enrolled. The mean age was 10.8±3.3 years and 74.2% were male. The radius was fractured in 99% of cases: distal radius 88.7% of which 26.8% involved the growth plate. Physicians performed a mean number of six (range one to 29) reductions with the aid of ultrasound and ranked its ease of use at a mean of 1.9±0.9 on a 5-point Likert scale (1 extremely easy, 5 extremely difficult); 77.3% reported that ultrasound helped with the reductions. Ultrasound revealed 83 adequate, 11 inadequate, two false negative (ie, ultrasound inadequate but fluoroscopy adequate) and no false positives yielding a sensitivity and specificity (95% CI) of 97.6% (94.4 to 100.9) and 100% for adequacy of reduction, respectively. The overall diagnostic accuracy was of 97.9%; only one of 16 physician had discordant fluoroscopy and ultrasound interpretations that occurred during their first 2/5 cases. Point-of-care ultrasound can be used reliably by most physicians to guide and determine adequacy of fracture reductions of distal radius fractures in children. Optimal training strategies need to be determined in order to ensure accurate interpretations.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».