The Role of Pain Scoring in Multi-detector Computed Tomography Indications in Pediatric Occult Fractures

Abstract

Introduction: Computed tomography (CT) is used in emergency orthopedic trauma cases with suspicion of fracture that cannot be detected on X-ray. Also pain during examination in patients with fracture is important for clinicians. We aimed to investigate whether pain severity is indicative of multi-detector CT (MDCT). Methods: A total of 175 patients included in the study. Visual analogue scale (VAS) was used to evaluate pre-examination pain in all patients. The most painful and suitable region for palpation were determined, palpated and the patients were asked to re-score their pain. In this way, the local VAS score was determined. MDCT was performed in all patients with general VAS of > 5. MDCT results were compared with the VAS scores. Results: Fracture detection in MDCT was 61.1% in patients with general VAS score of ≥ 5. Of the 105 patients with the local VAS score of ≥ 7, 90 had fractures. In these patients, the sensitivity, specificity, positive predictive value and negative predictive value of MDCT for detecting fractures were 84.1%, 77.9%, 85.7% and 75.7%, respectively. Conclusion: We believe that MDCT should be performed for suspected fracture if pain severity is high in isolated extremity trauma cases without fracture detection on X-ray.