• Manju Korattiyil, Rachel Long, Alessandra Guiner, Rong Huang, and Jo-Ann Nesiama.
• From the Division of Pediatric Emergency Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL.
• Pediatr Emerg Care. 2024 Dec 1; 40 (12): 876881876-881.

BackgroundMusculoskeletal injuries are one of the top 10 reasons children present to the emergency department (ED). Infrared thermal imaging (IRT) is a noninvasive and nonradiating imaging modality that can detect subtle temperature differences. IRT may be used to detect the presence of musculoskeletal injury.ObjectiveThis study aimed to assess the utility of a smart device infrared camera attachment's ability to localize acute pediatric long bone fractures in patients less than 5 years of age.MethodsThis was a prospective pilot study comparing thermal imagery on an injured extremity to radiographs. All IRT images were obtained via an iPad with an infrared camera attachment. Using two different IRT images (Hi/Lo and Span and Level), the area of maximum temperature ( Tmax ) was identified and compared to radiographs.ResultsA total of 31 patients were enrolled in the study. Twenty-four (77.50%) were identified as having fractures, and 7 (22.50%) did not have any fractures. IRT correctly identified an injury in the fracture group 91.67% of the time when using the Span and Level IRT image compared to standard x-rays ( P < 0.0002). When using the Span and Level image to identify Tmax to localize a fracture on x-ray, sensitivity is 0.92, specificity is 0.86, positive predictive value is 0.96, and negative predictive value is 0.75. A receiver operating characteristic (ROC) curve was completed with area under the curve (AUC) being 0.89.ConclusionsThis pilot study shows that the use of smart device infrared camera attachments is feasible and has promising results in fracture localization. This could allow for a decrease in radiographs and be particularly useful in resource-limited areas.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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