Dirsek travması ile acil servise başvuran ve dirsek grafisi çekilen pediatrik yaş grubu hastalarında kas iskelet ultrasonografisinin fraktür tanı veya taramasındaki yerinin direkt grafi ile karşılaştırılması
Comparison between musculoskeletal ultrasonography and direct radiography in fracture screening and diagnosis in pediatric patients who admitted to emergency department with elbow trauma and underwent elbow radiography.
- Tez No: 641762
- Danışmanlar: DR. ÖĞR. ÜYESİ YUSUF ALİ ALTUNCI
- Tez Türü: Tıpta Uzmanlık
- Konular: İlk ve Acil Yardım, Emergency and First Aid
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2020
- Dil: Türkçe
- Üniversite: Ege Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Acil Tıp Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 94
Özet
Giriş ve amaç: Travma pediatrik yaş grubunda sık hastane başvuru sebeplerindendir. Travma sonrası çocuklarda %10-25 oranında kırık görülmektedir. Dirsek bölgesi kırıkları çocuklarda tüm kırıkların %5-10 kadarını oluşturmaktadır. Çocuklarda dirsek travması sonrası ilk tercih edilen görüntüleme yöntemi konvansiyonel radyografidir. Ancak çekilen grafi sayısıyla saptanan kırık arasında büyük bir uyumsuzluk vardır. Grafinin iyonize radyasyon riski yanı sıra, grafi çekimi için pozisyon verilmesinde zorluklar ve büyüme plaklarına bağlı grafi değerlendirilmesindeki zorluklar gibi nedenlerle çocuklarda dirsek kırıklarının tanısında atlanma sık olmaktadır. Dirsekte bulunan büyüme plakları iyonize radyasyona duyarlı olduğu için çocuklarda grafi kararı dikkatli verilmelidir. Çalışmamızda pediatrik hasta grubunda USG'nin dirsek travmalarında kırık tanısı koyma ve taraması açısından direkt grafi ile karşılaştırılarak kullanışlı olup olmayacağını değerlendirmeyi amaçladık. Gereç ve yöntem: Ekim 2018-Aralık 2019 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Acil Servisi'ne dirsek travması sonrası başvuran ve primer hekimi tarafından dirsek grafisi görüntülemesi planlanan
Özet (Çeviri)
Introduction and objectives: Trauma is one of the common causes of hospital admissions in the pediatric age group. 10-25% fractures are seen in children after trauma. The proportion of elbow fractures is about 5-10% of all fractures in children. The first preferred imaging tool after elbow trauma in children is conventional radiography. However, there is a great inconsistency between the number of radiographs and the fracture detected. In addition to the risk of ionizing radiation in radiography, it is common to miss the diagnosis of elbow fractures in children due to difficulties in positioning for radiography and difficulties in evaluating radiography due to growth plates. As the growth plates in the elbow are sensitive to ionizing radiation the decision to perform radiographic imaging in children should be made carefully. In our study, we aimed to evaluate whether USG would be useful in the pediatric patient group by comparing it with conventional radiography in terms of diagnosing and excluding fractures in elbow traumas. Materials and Methods: Patients under 18 years old who were admitted to Ege University Faculty of Medicine Emergency Department due to elbow trauma between October 2018 and December 2019, who met the criteria of being included in the study and whose family gave consent were included in the study. The researcher evaluated the patient blindly to the results of the radiograph and filled the case report after bedside ultrasonography examination. The presence and absence of both fat pad sign and bone cortex scanning findings were evaluated by ultrasonography. We did not interfere with the primary physicians' patient management. The physicians who were blinded to the results of ultrasound evaluation, continued to care for the patient. Then, the patient's diagnosis was evaluated and compared with the diagnosis of ultrasonography. The diagnostic value of ultrasonography was calculated. In addition, the duration of ultrasound evaluation, the time taken for radiography, the duration of the stay in the emergency room and the radiography cost were also evaluated. Results: In our study, in which 122 patients were evaluated, 39 patients were diagnosed with fractures. In the study population, male gender (57%) and left side were more affected (53%). The mean age of the patients was 7.8 (± 4.5) (median: 7.7). The most common cause of trauma was falling from the same level (50%). Among physical examination findings, edema and limitation of motion were more closely related to the presence of fractures. It was calculated that the evaluation of the fat pad findings lasted average 15.4 seconds (±5.6), and the evaluation of the bone cortex took average 5.7 minutes (±1.8). The mean duration of radiography was 33.6 minutes (± 31.2) (median: 25.5, IQR:15.8-42.3), and the mean duration of stay in the emergency room was 208.7 minutes (± 189.9) (median: 148.5, IQR: 79-265.3). The emergency radiography cost of the patients was calculated as average 66.2₺ (± 40.3) X (median: 62.5, IQR: 31.3-90.5). When only the fat pad was evaluated on ultrasound, the sensitivity of ultrasonography was 82% and the specificity was 86%. The sensitivity of ultrasonography was 82% and specificity was 90% if only bone cortex scanning on ultrasound. When both fat pad and bone cortex scanning findings were evaluated together, the sensitivity of ultrasonography in pediatric elbow fractures was 95%, specificity 83% and negative predictive value 97%. If the USG findings are evaluated together with the physical examination findings, the absence of any fracture findings on ultrasound while there is no joint movement limitation excludes the diagnosis of fracture by 98.2%. Of the 122 patients included in our study, 114 were discharged, 2 were hospitalized, 4 were refused treatment / left at their own will, and 2 left the hospital without permission. 5 of our patients needed surgical treatment, and both fat pad and bone cortex scanning in USG were found positive in all of these patients. Conclusion: Besides its advantages such as being portable, providing bedside evaluation, being repeatable and not containing ionizing radiation, ultrasonography can be used as a diagnostic tool in pediatric elbow traumas with its high sensitivity and high negative predictive value. In addition, when USG evaluated together with the physical examination, it can reduce both hospital stay and cost by preventing unnecessary radiography in low-risk patients.
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