• Sun Hwa Lee and Seong Jong Yun.
• Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
• Ann Emerg Med. 2019 Oct 1; 74 (4): 493-502.

Study ObjectiveWe evaluate the diagnostic performance of ultrasonography for detection of elbow fracture in pediatric patients with trauma.MethodsPubMed and EMBASE databases were searched for diagnostic accuracy studies that used ultrasonography for detection of elbow fracture in pediatric patients. Bivariate modeling and hierarchic summary receiver operating characteristic (ROC) modeling were conducted to evaluate diagnostic performance. The pooled proportions of the false-negative rate were assessed with a DerSimonian-Laird random-effects model. We performed meta-regression analyses for heterogeneity exploration.ResultsTen articles involving a total of 519 patients were included. The summary sensitivity, summary specificity, and area under the hierarchic summary ROC curve were 96% (95% confidence interval 88% to 99%), 89% (95% confidence interval 82% to 94%), and 0.97 (95% confidence interval 0.95 to 0.98), respectively. The pooled proportion of the false-negative rate of ultrasonography was 3.7%. Among the various potential covariates, ultrasonographic performer (pediatric emergency physician versus others) and presence of extra musculoskeletal ultrasonographic training (trained versus not reported) were associated with heterogeneity of the specificity.ConclusionElbow ultrasonography demonstrated high performance in the diagnosis of pediatric elbow fracture, particularly in studies of physicians with extra training in musculoskeletal ultrasonography. Ultrasonography may be performed by trained physicians as a first-line diagnostic tool to diagnose pediatric elbow fracture.Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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