Abstract
Wrist trauma is common in children, typically requiring radiography for diagnosis and treatment planning. However, many children do not have fractures and are unnecessarily exposed to radiation. Ultrasound performed at bedside could detect fractures prior to radiography. Modern tools including three-dimensional ultrasound (3DUS) and artificial intelligence (AI) have not yet been applied to this task. Our purpose was to assess (1) feasibility, reliability, and accuracy of 3DUS for detection of pediatric wrist fractures, and (2) accuracy of automated fracture detection via AI from 3DUS sweeps. Children presenting to an emergency department with unilateral upper extremity injury to the wrist region were scanned on both the affected and unaffected limb. Radiographs of the symptomatic limb were obtained for comparison. Ultrasound scans were read by three individuals to determine reliability. An AI network was trained and compared against the human readers. Thirty participants were enrolled, resulting in scans from fifty-five wrists. Readers had a combined sensitivity of 1.00 and specificity of 0.90 for fractures. AI interpretation was indistinguishable from human interpretation, with all fractures detected in the test set of 36 images (sensitivity = 1.0). The high sensitivity of 3D ultrasound and automated AI ultrasound interpretation suggests that ultrasound could potentially rule out fractures in the emergency department.
Highlights
Fractures are the third leading cause of pediatric hospitalizations in Canada [1]
When children present to primary care clinics or emergency department (ED) with suspected wrist fractures, radiographs are the standard of care as they allow for precise examination of the anatomy
Unilateral arm radiographs of all 30 patients were assessed, revealing 19 distal forearm fractures
Summary
Fractures are the third leading cause of pediatric hospitalizations in Canada [1]. Distal radius fractures typically occur in children falling on an outstretched hand and involve the metaphysis or physis [2]. When children present to primary care clinics or emergency department (ED) with suspected wrist fractures, radiographs are the standard of care as they allow for precise examination of the anatomy. Routine radiographs are performed on patients with wrist trauma, but only half of the imaging reveals fractures [4]. Obtaining radiographs in ED typically involves sending the patient to a separate diagnostic imaging area, where they wait in an additional queue, and transferring them back, a process which can add hours to an ED visit. If clinicians could determine at bedside who has a fracture and requires an X-ray, systemwide radiation doses and costs could be reduced and ED visits shortened
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