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Objective: To investigate the diagnostic accuracy and time in the detection of fractures on pediatric foot radiographs marked without and with localization cues.

Method: One-hundred randomly selected foot radiographic examinations that were performed on children (<18 years old) after injury and with at least 4 weeks of follow-up were included. Blinded to history and diagnosis, 4 readers (one each: medical student, pediatrician, pediatric orthopedic surgeon, and pediatric musculoskeletal radiologist) retrospectively and independently reviewed each examination twice (without and with cue, at least 1 month apart, and after randomization). Each reader recorded the presence or absence of a fracture, fracture location, diagnostic confidence, and the total (interpretation) time spent on each study. Diagnostic accuracy, reader confidence, and interpretation time were compared between examinations without and with cues.

Results: Our study included 59 examinations without and 41 with fractures (21 phalangeal, 18 metatarsal, and 2 tarsal fractures). Localization cues improved inter-reader agreement (κ=0.36 to 0.64), overall sensitivity (68 to 72%), specificity (66 to 73%), and diagnostic accuracy (67 to 73%); thus, overcalled and missed rates also improved from 34 to 27% and 32 to 28%, respectively. Reader confidence improved with cue (49 to 61%, p<0.01) with higher incremental improvement with younger children (30% for 1-6 years; 14% for 7-11 years; and 10% for 12-17 years). Interpretation time decreased by 40% per examination (40±22 s without to 24±13 s with cues, p<0.001).

Conclusion: Localization cues improved diagnostic accuracy and reader confidence, reducing interpretation time in the detection of pediatric foot fractures.

Titel:	Identification of fractures on pediatric foot radiographs: do localization cues improve diagnostic accuracy and reduce interpretation time?
Autor/in / Beteiligte Person:	Patel, V ; Tariq, SM ; Hong, S ; Guariento, A ; Davidson, R ; Nguyen, JC
Link:	View record at Springer (Volltext)
Zeitschrift:	Skeletal radiology, Jg. 53 (2024-02-01), Heft 2, S. 345-352
Veröffentlichung:	Berlin : Springer Verlag ; <i>Original Publication</i>: Berlin, New York, Springer International., 2024
Medientyp:	academicJournal
ISSN:	1432-2161 (electronic)
DOI:	10.1007/s00256-023-04401-9
Schlagwort:	Humans Child Adolescent Cues Retrospective Studies Sensitivity and Specificity Radiography Fractures, Bone diagnostic imaging Foot Injuries diagnostic imaging
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Skeletal Radiol] 2024 Feb; Vol. 53 (2), pp. 345-352. <i>Date of Electronic Publication: </i>2023 Jul 25. MeSH Terms: Fractures, Bone* / diagnostic imaging ; Foot Injuries* / diagnostic imaging ; Humans ; Child ; Adolescent ; Cues ; Retrospective Studies ; Sensitivity and Specificity ; Radiography References: Lambers K, Ootes D, Ring D. Incidence of patients with lower extremity injuries presenting to US emergency departments by anatomic region, disease category, and age. Clin Orthop Relat Res. 2012;470(1):284–90. (PMID: 10.1007/s11999-011-1982-z21785896) ; Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res Off J Am Soc Bone Miner Res. 2004;19(12):1976–81. (PMID: 10.1359/jbmr.040902) ; Chaturvedi A, Mann L, Cain U, Chaturvedi A, Klionsky NB. 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Identification of fractures on pediatric foot radiographs: do localization cues improve diagnostic accuracy and reduce interpretation time?