<scp>Point‐of‐Care</scp>Ultrasound Evaluation of Ankle Injuries in Children
Bibliographic record
Abstract
OBJECTIVES: To determine if point-of-care ultrasound (POCUS) of ankle injuries in children, in conjunction with validated ankle injury clinical prediction rules, can accurately diagnose ankle fracture in children. METHODS: A prospective observational study was conducted on patients (birth-21 years) presenting to a pediatric emergency department with an ankle injury requiring ankle radiograph. POCUS of the injured ankle was performed to evaluate for fracture. Clinical prediction rule scores (Ottawa Ankle and Low Risk Ankle) were recorded along with pre- and post-ultrasound clinical suspicion for fracture. Diagnosis of ankle fracture was confirmed via radiology radiograph report. Test characteristics of sensitivity, specificity, positive and negative predictive values were calculated. RESULTS: Forty-eight patients were enrolled, 58% were female, with a mean age of 12.2 years (SD 3.8). Twelve (25%) patients had ankle POCUS positive or indeterminate for fracture. Nine (19%) patients had fracture based on radiograph, and 6 of the 9 (67%) patients with fracture had open growth plates. Ankle POCUS was found to have a sensitivity of 56% (95% confidence interval [CI], 23-85%), specificity of 82% (95% CI, 66-92%), positive predictive value of 42% (95% CI, 17-71%), and negative predictive value of 89% (95% CI, 73-96%). CONCLUSIONS: Our findings suggest that ankle POCUS in children is a difficult application to perform and interpret compared with radiographic diagnosis of fracture. Open growth plates may complicate accurate identification of fracture using POCUS and at this time serves as a poor screening exam to assess for fracture or the need for radiographs.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".