Point-of-care ultrasound potential for paediatrics

Forearm fractures are very common in children with a research project exploring the benefits of point-of-care ultrasound for diagnosis.

Led by Dr. Peter Snelling, staff specialist in emergency medicine at Gold Coast Health, the clinical trial is called BUCKLED – Bedside Ultrasound Conducted in Kids with distal upper Limb fractures in the Emergency Department.

Dr Snelling has a long-standing interest in point-of-care ultrasound as it relates to clinical practice, particularly in paediatrics, as is it is something that is quick to do, painless, and can give immediate information at the bedside without ionising radiation.

He first started researching point-of-care ultrasound in 2017 while working as a consultant at the Queensland Children’s Hospital emergency department, exploring the use of ultrasound conducted by nurse practitioners compared with x-ray imaging.

Out of that research, Dr Snelling was interested to pursue the topic further rolling it into his PhD, and is now exploring the benefits of point-of-care ultrasound for children with broken arms.

BUCKLED is a randomised controlled trial that will compare the use of portable ultrasound and x-ray imaging and determine if there are differences in functional outcomes, patient and care-giver preferences, and health system benefits.

The clinical trial is aiming for a patient target of 300 and is well over halfway. Dr Snelling expects they will probably finish early next year.

The project has received funding support from Queensland Health (Queensland Advancing Clinical Research Fellowship) and a grant from the Emergency Medicine Foundation.

Dr Snelling believes point-of-care ultrasound has potential as an alternative to x-ray imaging citing his first study which found that two thirds of children had a sprain (no fracture) or a buckle fracture.

“Those children shouldn’t require x-ray imaging provided they are diagnosed and treated accordingly,” he said.

“For families it can be useful for them to see the pathology and show them in real time what we are scanning and demonstrate why we need an x-ray or can treat and discharge.”

Dr Snelling said the technology could potentially benefit workflow as well as being cost saving by reducing the number of x-rays being conducted.

One of the main questions Dr Snelling hopes to answer is the utility of point-of-care ultrasound as a diagnostic tool.

He said while it has a lot of benefit, the question is whether nurse practitioners will regularly use it as there are systems in place for x-rays and reporting.

“There needs to be investment in training processes but once attained it’s easier to adapt and use point-of-care ultrasound for other related issues.”

He said the technology also has potential for use in remote, rural, and regional areas where access to x-ray is limited – “this could be a tool in their bag to help make decisions about transfers.”

To keep up to date with Dr Snelling’s research you can follow the trial on Twitter [@Buckled_RCT] or online via Dr Snelling’s research group Sonar – Sonography innovation and research group.

Follow Dr Peter Snelling [@PEM_Ultrasound]


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