The use of ultrasonography (USG) to diagnose suspected arm fractures in children was non-inferior to x-rays, according to a study from Australia reported in the New England Journal of Medicine.¹

In this multicenter, non inferiority trial, 270 participants, aged 5-15 years, were enrolled to compare the use of point-of-care USG and x-rays to diagnose suspected fractures in children, who presented to the ED with pain in the distal forearm but clinically no visible deformity. If USG was indicative of fracture, then x-ray was done to confirm the diagnosis. The participants were followed up at 1, 4 and 8 weeks to assess progress of healing. The Pediatric Upper Extremity Short Patient-Reported Outcomes Measurement Information System (PROMIS) score, ranging from 8-40, was used to evaluate function. Higher scores were indicative of better function.

Results showed no difference between the two groups at 4 weeks; the mean PROMIS scores in the USG group (36.4 points) were non-inferior to those in the radiography group (36.3 points), with mean difference of 0.1 point. Use of USG did not result in any clinically important fractures that were missed. No significant differences were observed between the two groups with regard to adverse events.

This study highlights the potential role of ultrasound in diagnosing fractures, especially in remote areas. Since USG was noninferior to x-ray, it may be a reliable tool to diagnose fractures in children. In addition, it may alleviate parental concern about exposure of their children to x-rays and also reduce the waiting time.

Reference

1. Peter J. Snelling et al, Ultrasonography or radiography for suspected pediatric distal forearm fractures. N Engl J Med. 2023 Jun 1;388(22):2049-2057. DOI: 10.1056/NEJMoa2213883.