Evaluating the accuracy of bedside ultrasound to diagnose wrist fractures in children

BUCKLED: Bedside Ultrasound Conducted in Kids with suspected distal upper Limb fractures in the Emergency Department - a study of accuracy, tolerability and feasibility

Status

Completed

Phases

Unknown

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12617001648314

Acronym

BUCKLED: Bedside Ultrasound Conducted in Kids with suspected distal upper Limb fractures in the Eme

Enrollment

206

Registered

2017-12-21

Start date

2018-02-05

Completion date

2019-04-06

Last updated

2021-03-29

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

Paediatric distal forearm fractures, usually of the radius, are a common presentation to the emergency department (ED). Buckle, or torus, fractures occur in children due to the deformation of their soft bone, without breech of cortex. The gold standard for diagnosis of these fractures is x-ray imaging, which can then be effectively treated with a wrist splint. It has also been demonstrated that they can be accurately diagnosed by a rapid ultrasound protocol that can be easily learnt. Ultrasound is not typically utilised in this fashion in a tertiary paediatric ED due to readily available x-ray imaging. However, regional services often have limited radiographic services after-hours. Nurse practitioners (NPs) are frontline workers in the ambulatory care area of the ED where they are heavily relied upon for the diagnosis and management of paediatric fractures. If it can be demonstrated that NPs with limited ultrasound experience can diagnose distal forearm buckle fractures with high accuracy after a short training course, there may be validity in similar front-line workers being trained in this modality in resource-limited environments. This pilot study will determine the acceptability, tolerability (pain compared to radiograph), feasibility (time of scan), and the accuracy of NPs to diagnose buckle fractures using ultrasound compared to radiograph as the gold standard. The results from the pilot study would be used to inform the development of a larger multi-centre research project that incorporates regional sites.

Interventions

Nurse practitioners will utilise bedside ultrasound prospectively to evaluate children 4-16 years of age with a non-angulated distal forearm injury presenting to the emergency department. A convenience sample of 200 patients will be collected over a 12-month period to determine the accuracy of bedside ultrasound compared with standard radiographs. Eligible patients will be consented to have ultrasound performed prospectively prior to x-ray imaging.

Study design

Allocation

Non-randomised trial

Intervention model

Single group

Primary purpose

Diagnosis

Masking

Open (masking not used)

Eligibility

Sex/Gender

All

Age

4 Years to 16 Years

Healthy volunteers

Inclusion criteria

• Children aged 4-16 years presenting to the emergency department • Isolated, non-angulated distal third forearm injury being evaluated with radiography for suspected fracture • Acute injury sustained within 1 week of presentation

Exclusion criteria

• External imaging has already been performed • Known metabolic bone disease, such as osteogenesis imperfecta • Suspicion of non-accidental injury • Congenital bone malformation • Compound fracture • Neurovascular compromise • Distracting injury • Suspicion for hand fracture

Outcome results