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A Simulation Model for the Handheld Ultrasound Diagnosis of Pediatric Forearm Fractures

Published online by Cambridge University Press:  15 September 2023

Merve Eksioglu Open the ORCID record for Merve Eksioglu [Opens in a new window]  and
Burcu Azapoglu Kaymak Open the ORCID record for Burcu Azapoglu Kaymak [Opens in a new window]
Merve Eksioglu*
Affiliation:
University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Department of Emergency Medicine - Atasehir Istanbul, Turkey
Burcu Azapoglu Kaymak
Affiliation:
University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Department of Emergency Medicine - Atasehir Istanbul, Turkey
*
Correspondence: Merve Eksioglu, MD University of Health Sciences Fatih Sultan Mehmet Education and Research Hospital Department of Emergency Medicine Atasehir Istanbul, Turkey E-mail: mervekoyunoglu@gmail.com
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Abstract

Introduction:

Handheld ultrasound (HHU) devices have gained prominence in emergency care settings and post-graduate training, but their application in the diagnosis of pediatric fractures remains under-explored. The aim of this study is to evaluate the effectiveness and accuracy of an HHU device for diagnosing pediatric forearm fractures using a simulation model.

Methods:

The materials for the basic pediatric fracture model include turkey bones soaked in white vinegar to make them pliable, food-grade gelatine, and plastic containers. Ultrasound analysis of the models was done with an HHU device, Sonosite İViz US (FUJIFILM Sonosite, Inc.; Bothell, Washington USA). Four different fracture patterns (transverse fracture, oblique fracture, greenstick fracture, and a torus fracture) and one model without fracture were used in this study. Twenty-six Emergency Medicine residents sonographically evaluated different bone models in order to define the presence and absence of fracture and the fracture subtype. The participants’ ability to obtain adequate images and the time taken to create and recognize the images were evaluated and recorded. After the sonographic examination, the residents were also asked for their opinion on the model as a teaching tool.

Results:

All participants (100%) recognized the normal bone model and the fracture, regardless of the fracture type. The consistency analysis between the practitioners indicated a substantial agreement (weighted kappa value of 0.707). The duration to identify the target pathology in fracture models was significantly longer for the greenstick fracture (78.57 [SD = 30.45] seconds) model compared to other models. The majority of participants (92.3%) agreed that the model used would be a useful teaching tool for learning ultrasound diagnosis of pediatric forearm fractures.

Conclusions:

All participants successfully identified both the normal bone model and the presence of fractures, irrespective of the fracture type. Significantly, the identification of the greenstick fracture took longer compared to other fracture types. Moreover, the majority of participants acknowledged the model’s utility as a teaching tool for learning ultrasound diagnosis of pediatric forearm fractures.

Keywords

handheld ultrasoundpediatric forearm fracturepocket sized ultrasoundpoint-of-care ultrasoundultrasound simulation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 5 , October 2023 , pp. 589 - 594
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Naranje, SM, Erali, RA, Warner, WC Jr, Sawyer, JR, Kelly, DM. Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop. 2016;36(4):e45–48.CrossRefGoogle ScholarPubMed
Patel, DS, Statuta, SM, Ahmed, N. Common fractures of the radius and ulna. Am Fam Physician. 2021;103(6):345–354.Google ScholarPubMed
Douma-den Hamer, D, Blanker, MH, Edens, MA, et al. Ultrasound for distal forearm fracture: a systematic review and diagnostic meta-analysis. PLoS One. 2016;11(5):e0155659.CrossRefGoogle ScholarPubMed
Snelling, PJ. Getting started in pediatric emergency medicine point-of-care ultrasound: five fundamental applications. Australas J Ultrasound Med. 2020;23(1):5–9.CrossRefGoogle Scholar
Handoll, HH, Elliott, J, Iheozor-Ejiofor, Z, Hunter, J, Karantana, A. Interventions for treating wrist fractures in children. Cochrane Database Syst Rev. 2018;12(12):CD012470.Google ScholarPubMed
Baribeau, Y, Sharkey, A, Chaudhary, O, et al. Handheld point-of-care ultrasound probes: the new generation of POCUS. J Cardiothorac Vasc Anesth. 2020;34(11):3139–3145.CrossRefGoogle ScholarPubMed
Tarique, U, Tang, B, Singh, M, Kulasegaram, KM, Ailon, J. Ultrasound curricula in undergraduate medical education: a scoping review. J Ultrasound Med. 2018;37(1):69–82.CrossRefGoogle ScholarPubMed
Dinh, VA, Fu, JY, Lu, S, Chiem, A, Fox, JC, Blaivas, M. Integration of ultrasound in medical education at United States medical schools: a national survey of directors’ experiences. J Ultrasound Med. 2016;35(2):413–419.CrossRefGoogle ScholarPubMed
Andersen, GN, Viset, A, Mjølstad, OC, Salvesen, O, Dalen, H, Haugen, BO. Feasibility and accuracy of point-of-care pocket-size ultrasonography performed by medical students. BMC Med Educ. 2014;14:156.10.1186/1472-6920-14-156CrossRefGoogle ScholarPubMed
Ojeda, JC, Colbert, JA, Lin, X, et al. Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial. J Gen Intern Med. 2015;30(2):199–206.CrossRefGoogle ScholarPubMed
Bennett, D, De Vita, E, Mezzasalma, F, et al. Portable pocket-sized ultrasound scanner for the evaluation of lung involvement in coronavirus disease 2019 patients. Ultrasound Med Biol. 2021;47(1):19–24.CrossRefGoogle ScholarPubMed
Chetioui, A, Masia, T, Claret, PG, et al. Pocket-sized ultrasound device for internal jugular puncture: a randomized study of performance on a simulation model. J Vasc Access. 2019;20(4):404–408.10.1177/1129729818812733CrossRefGoogle ScholarPubMed
Thavanathan, RS, Woo, MY, Hall, G. The future is in your hands - handheld ultrasound in the emergency department. CJEM. 2020;22(6):742–744.10.1017/cem.2020.449CrossRefGoogle ScholarPubMed
Akimoto, T, Kobayashi, T, Maita, H, Osawa, H, Kato, H. Initial assessment of femoral proximal fracture and acute hip arthritis using pocket-sized ultrasound: a prospective observational study in a primary care setting in Japan. BMC Musculoskelet Disord. 2020;21(1):291.CrossRefGoogle Scholar
Snelling, PJ. A low-cost ultrasound model for simulation of pediatric distal forearm fractures. Australas J Ultrasound Med. 2018;21(2):70–74.CrossRefGoogle Scholar
Heiner, JD, McArthur, TJ. A simulation model for the ultrasound diagnosis of long-bone fractures. Simul Healthc. 2009;4(4):228–231.10.1097/SIH.0b013e3181b1a8d0CrossRefGoogle ScholarPubMed
Gindhart, PS. Growth standards for the tibia and radius in children aged one month through eighteen years. Am J Phys Anthropol. 1973;39(1):41–48.CrossRefGoogle ScholarPubMed
Marshburn, TH, Legome, E, Sargsyan, A, et al. Goal-directed ultrasound in the detection of long-bone fractures. J Trauma. 2004;57(2):329–332.10.1097/01.TA.0000088005.35520.CBCrossRefGoogle ScholarPubMed
Patel, DD, Blumberg, SM, Crain, EF. The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children. Pediatr Emerg Care. 2009;25(4):221–225.CrossRefGoogle ScholarPubMed
Snelling, PJ, Jones, P, Moore, M, et al. Describing the learning curve of novices for the diagnosis of pediatric distal forearm fractures using point-of-care ultrasound. Australas J Ultrasound Med. 2022;25(2):66–73.CrossRefGoogle ScholarPubMed
Weinberg, ER, Tunik, MG, Tsung, JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41(8):862–868.CrossRefGoogle ScholarPubMed
Ireson, M, Warring, S, Medina-Inojosa, JR, et al. First year medical students, personal handheld ultrasound devices, and introduction of insonation in medical education. Ann Glob Health. 2019;85(1):123.10.5334/aogh.2565CrossRefGoogle ScholarPubMed
Andersen, GN, Viset, A, Mjølstad, OC, Salvesen, O, Dalen, H, Haugen, BO. Feasibility and accuracy of point-of-care pocket-size ultrasonography performed by medical students. BMC Med Educ. 2014;14:156.CrossRefGoogle ScholarPubMed
Ojeda, JC, Colbert, JA, Lin, X, et al. Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial. J Gen Intern Med. 2015;30(2):199–206.10.1007/s11606-014-3086-4CrossRefGoogle ScholarPubMed
Katzer, C, Wasem, J, Eckert, K, Ackermann, O, Buchberger, B. Ultrasound in the diagnostics of metaphyseal forearm fractures in children: a systematic review and cost calculation. Pediatr Emerg Care. 2016;32(6):401–407.CrossRefGoogle ScholarPubMed
Epema, AC, Spanjer, MJB, Ras, L, Kelder, JC, Sanders, M. Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study. Emerg Med J. 2019;36(10):613–616.CrossRefGoogle ScholarPubMed
Snelling, PJ, Jones, P, Keijzers, G, Bade, D, Herd, DW, Ware, RS. Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study. Emerg Med J. 2021;38(2):139–145.CrossRefGoogle Scholar
Rowlands, R, Rippey, J, Tie, S, Flynn, J. Bedside ultrasound vs X-ray for the diagnosis of forearm fractures in children. J Emerg Med. 2017;52(2):208–215.CrossRefGoogle ScholarPubMed
Poonai, N, Myslik, F, Joubert, G, et al. Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Acad Emerg Med. 2017;24(5):607–616.CrossRefGoogle Scholar
Lau, BC, Robertson, A, Motamedi, D, Lee, N. The validity and reliability of a pocket-sized ultrasound to diagnose distal radius fracture and assess quality of closed reduction. J Hand Surg Am. 2017;42(6):420–427.10.1016/j.jhsa.2017.03.012CrossRefGoogle ScholarPubMed
Rodríguez-Merchán EC. Pediatric fractures of the forearm. Clin Orthop Relat Res. 2005;(432):65–72.Google Scholar