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    Diagnostic accuracy of point-of-care ultrasonography in physeal fractures
    (W B Saunders Co-Elsevier Inc, 2026) Gurkan, Onur; Kozaci, Nalan; Colak, Songul; Aydin, Ismail Erkan
    Objective: The aim of this study was to compare the accuracy of Point of Care Ultrasound (POCUS) with X-ray (XR) in the diagnosis of physeal fractures and Salter-Harris classification in pediatric patients. Methods: The study was conducted in a university hospital emergency department between January 1, 2024 and June 30, 2025. Pediatric patients aged 0-18 years who were admitted to the emergency department due to extremity trauma, had stable vital signs, and presented with suspected physeal fractures on physical examination were included in this prospective study. Results: A total of 117 patients were included in the study. Fractures were detected on XR in 73 % of patients. Compared with XR, POCUS demonstrated a sensitivity (Sn) of 97 %, specificity (Sp) of 94 %, positive predictive value (PPV) of 98 %, negative predictive value (NPV) of 91 % (AUC: 0.951, 95 % CI: 0.90-1.00), and a kappa value of 0.894 for fracture detection. For physeal fractures, POCUS showed Sn 93 %, Sp 95 %, PPV 74 %, NPV 99 % (AUC: 0.942, 95 % CI: 0.87-1.00) and kappa = 0.794. For detecting the extension of the fracture into the joint space, POCUS showed Sn 62 %, Sp 100 %, PPV 54 %, NPV 100 % (AUC: 0.810; 95 % CI: 0.68-0.94) and a kappa value of 0.727. Moderate concordance was observed between POCUS and XR for Salter-Harris classification (kappa = 0.673). Conclusion: POCUS demonstrates high sensitivity in detecting traumatic extremity fractures and physeal fractures in pediatric patients. However, only moderate concordance was observed between POCUS and XR in assessing the extension of the fracture into the joint space and in applying the Salter-Harris classification. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.