HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chapman, V. Articles by Jaramillo, D. Search for Related Content PubMed PubMed Citation Articles by Chapman, V. Articles by Jaramillo, D. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

MDCT of the Elbow in Pediatric Patients with Posttraumatic Elbow Effusions

¹ The Children's Hospital of Denver, 7136 S Hudson Ct., Centennial, CO 80122.
² Massachusetts General Hospital for Children, Boston, MA.
³ Radiology Imaging Associates, Englewood, CO.
⁴ Children's Hospital of Philadelphia, Philadelphia, PA.

OBJECTIVE. The purpose of this study was to determine the performance characteristics of MDCT in the detection of fractures in children with posttraumatic elbow effusions and to assess the effect of MDCT findings on clinical management.

SUBJECTS AND METHODS. Unenhanced MDCT of the elbow was prospectively performed without sedation on 31 children 20 months to 16 years old who had posttraumatic elbow effusions. Two blinded reviewers independently and in consensus characterized all MDCT scans as positive or negative for the presence of fracture. Level of interobserver agreement was determined with the kappa statistic. Sensitivity, specificity, positive predictive value, and negative predictive value of MDCT for fracture detection were determined for the consensus MDCT interpretations with follow-up radiographs as the reference standard. Patients were treated with casts and instructed to return in 2-3 weeks for clinical and radiographic follow-up unless a change in management was indicated on the basis of MDCT findings. The frequency of alteration of management was determined.

RESULTS. Both reviewers detected fractures in 15 (48%) of the patients individually and in 16 (52%) of the patients by consensus. Interobserver agreement for fracture detection with MDCT was excellent ( = 0.85). The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in the detection of fractures were 92%, 79%, 79%, and 92%, respectively. Four (13%) of the children had changes in management based on the MDCT findings.

CONCLUSION. MDCT is a sensitive means of evaluating for radiographically occult fractures in children with posttraumatic elbow effusions. It has a high negative predictive value and a high level of interobserver agreement. MDCT findings may lead to alteration of treatment of children with nondisplaced lateral condylar and radial head fractures.

Keywords: elbow • fracture • MDCT • pediatric • trauma

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				L. M. Fayad, F. Corl, and E. K. Fishman Pediatric Skeletal Trauma: Use of Multiplanar Reformatted and Three-dimensional 64-Row Multidetector CT in the Emergency Department RadioGraphics, January 1, 2009; 29(1): 135 - 150. [Abstract] [Full Text] [PDF]