Ultrasonography Noninferior to Radiography for Pediatric Distal Forearm Injury

Ultrasonography noninferior for physical function of the affected arm at four weeks for patients aged 5 to 15 years

By Elana Gotkine HealthDay Reporter

MONDAY, June 5, 2023 (HealthDay News) — For children presenting to the emergency department with an isolated distal forearm injury, initial point-of-care ultrasonography is noninferior to radiography for physical function of the affected arm at four weeks, according to a study published in the June 1 issue of the New England Journal of Medicine.

Peter J. Snelling, M.B.B.S., M.P.H., from the School of Medicine and Dentistry and Menzies Health Institute Queensland in Brisbane, Australia, and colleagues conducted a multicenter, noninferiority trial involving patients aged 5 to 15 years who presented to the emergency department with an isolated distal forearm injury without clinically visible deformity. Participants were randomly assigned to an initial point-of-care ultrasonography or radiography and were followed for eight weeks. Physical function of the affected arm at four weeks was assessed as the primary outcome with the validated Pediatric Upper Extremity Short Patient-Reported Outcomes Measurement Information System (PROMIS) score.

Outcomes were available for 262 of the 270 participants enrolled. The researchers found that PROMIS scores at four weeks were noninferior in the ultrasonography group versus the radiography group (mean, 36.4 and 36.3 points; mean difference, 0.1 point; 95 percent confidence interval, −1.3 to 1.4). In 266 participants with primary outcome data recorded at any time, intention-to-treat analyses produced similar results (mean difference, 0.1 point; 95 percent confidence interval, −1.3 to 1.4). No clinically important fractures were missed.

“Ultrasonography was noninferior to radiography in the outcome of physical function of the arm at four weeks, with no between-group differences in the occurrence of adverse events,” the authors write.

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