Functional outcomes for pediatric arm fracture just as good with initial POCUS instead of initial radiography (BUCKLED)

Référence

Snelling PJ, Jones P, Bade D, et al for the BUCKLED Trial Group. Ultrasonography or radiography for suspected pediatric distal forearm fractures. N Engl J Med 2023;388(22):2049-2057.

Sommaire

A previous POEM reported that point-of-care ultrasonography (POCUS) is highly accurate for the diagnosis of pediatric arm fracture. This study looked at whether using ultrasonography instead of radiography had any impact on functional outcomes at 1 month. These researchers at 4 Australian emergency departments identified 270 children aged 5 years to 15 years who presented with an isolated distal forearm injury and no visible deformity. The patients were randomized to receive initial POCUS or initial radiography. At baseline, the mean age was slightly older than 10 years in both groups, and approximately 65% of the injuries were the result of a fall on an outstretched arm. Allocation was concealed and analysis was by intention to treat. Patients were classified as no fracture, buckle fracture, or other fracture. Almost half the patients in the POCUS group also received a radiograph. The primary outcome was the 8-item Pediatric Upper Extremity Short Patient-Reported Outcomes Measurement Information System (PROMIS) score 1 month after the injury, which measures arm function and has a range from 8 to 40 points. The researchers prespecified a 5-point difference as the margin for noninferiority (ie, if the scores in the 2 groups were within 5 points, then POCUS was noninferior to radiography). At 4 weeks, there was essentially no difference between groups in PROMIS scores (this was also true at 1 week and 8 weeks). Length of stay in the emergency department was a bit shorter for the POCUS group (by 15 minutes) and satisfaction was a bit higher in the POCUS group. Kids in the POCUS group also missed a median of 0.5 fewer days of school. Cost was not reported.