Büyüme çizgisi kırıklarının tanısında nokta bakım ultrasonografinin doğruluğunun değerlendirilmesi
[ X ]
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Alanya Alaaddin Keykubat Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Bu tez çalışmasının amacı, acil servise travma nedeni ile başvuran ve fizik muayenesinde büyüme çizgisi kırığı şüphesi olan pediatrik hastalarda, kırıklarının tanısı ve kırık özelliklerinin tanımlanmasında Point of Care Ultrasound (POCUS)'un etkinliğini direk grafi (XR) ile karşılaştırılarak ortaya koymaktır. Prospektif olarak yapılan bu tez çalışmasına acil servise travma nedeniyle başvuran, hayati tehlikesi olmayan, klinik bulguları stabil olan, fizik muayenede büyüme çizgisi kırık şüphesi olan 0-18 yaş arasındaki çocuk hastalar alındı. Hastaları değerlendiren ilk hekim POCUS muayenesi yaptı, ikinci hekim XR görüntülerini yorumladı. XR ve POCUS görüntülerinde kırık varlığı, fizise uzanımı, ekleme uzanımı açılanma, basamaklanma, kırık tipi, çıkık ve Salter-Harris (SH) sınıflaması değerlendirildi. POCUS'un XR'a göre doğruluğunu değerlendirmek için ROC (Receiver operating characteristic) analizi ve Kappa (?) değeri kullanıldı. ? büyüklüğüne göre uyumluluk derecelendirildi. ? değerinin 0.75'ten büyük olması mükemmel uyum; 0.75-0.40 arası orta uyum; 0.40'ın altında olması ise zayıf uyum olarak kabul edildi. Çalışmaya 117 hasta alındı. Bu hastaların 85'inde kırık saptandı. XR ile karşılaştırıldığında POCUS'un kırığı saptamada sensitivitesi %97, spesifitesi %94, fizis kırığını saptamada sensitivitesi %94, spesifitesi %96, ekleme uzanan kırığı saptamada sensitivitesi %60, spesifitesi %71 bulundu. Açılanma, basamaklanma ve komşu kemik kırığı için sensitivite %100 olarak hesaplandı. POCUS'un XR'a göre kırıkların tiplendirilmesinde kappa değeri 0.881; çıkıkların tespit edilmesinde 0.742 bulundu. XR'da tespit edilen fizis kırıklarının 8'i (%50) SH tip II, 3'ü (%19) SH tip III, 5'i (%31) SH IV idi. SH sınıflamasında POCUS'un XR'a göre kappa değeri 0.682 bulundu. POCUS ile hastaların 30'unda (%26) dokuda hematom ve 5'inde (%4) hemartroz saptandı. Çocuklarda travmaya bağlı kemik kırıklarının görüntülenmesinde, fizise uzanan kırıkların saptanmasında POCUS'un duyarlılığı yüksektir. Aynı zamanda POCUS ile yumuşak doku yaralanmaları görüntülenebilir. Buna karşılık kırığın eklem içine uzanımında, çıkıkların tespit edilmesinde ve SH sınıflamasında XR ile POCUS arasında orta düzeyde uyum vardır. Anahtar Kelimeler: Fizis, kırık, çocuklar, direkt grafi, POCUS
The aim of this thesis study is to demonstrate the effectiveness of Point of Care Ultrasound (POCUS) in the diagnosis of fractures and identification of fracture characteristics in pediatric patients with suspected growth line fracture on physical examination who presented to the emergency department due to trauma and compare it with plain radiography (XR). In this prospective thesis study, children aged 0-18 years who applied to the emergency department due to trauma, who were not in life-threatening condition, whose clinical findings were stable, and who had suspected growth line fractures on physical examination were included. The first physician who evaluated the patients performed POCUS examination and the second physician interpreted the XR images. The presence of fracture, extension to the physis, extension to the joint, angulation, stepping, fracture type, dislocation, and Salter Harris (SH) classification were evaluated in XR and POCUS images. ROC (Receiver operating characteristic) analysis and Kappa (?) value were used to evaluate the accuracy of POCUS compared to XR. The agreement was graded according to the ? magnitude. A ? value greater than 0.75 was considered excellent agreement; between 0.75-0.40 was considered moderate agreement; and below 0.40 was considered poor agreement. 117 patients were included in this study. Fractures were detected in 85 of these patients. Compared to XR, POCUS had a sensitivity of 97% and specificity of 94% in detecting fractures, a sensitivity of 94% and specificity of 96% in detecting physis fractures, and a sensitivity of 60% and specificity of 71% in detecting fractures extending to the joint. Sensitivity was calculated as 100% for angulation, stepping, and adjacent bone fractures. The kappa value of POCUS in the typing of fractures according to XR was 0.881; and in the detection of dislocations, it was 0.742. Of the physis fractures detected on XR, 8 (50%) were SH type II, 3 (19%) were SH type III, and 5 (31%) were SH IV. The kappa value of POCUS compared to XR in SH classification was found to be 0.682. POCUS revealed tissue hematoma in 30 (26%) patients and hemarthrosis in 5 (4%) patients. POCUS has a high sensitivity in the visualization of trauma-related bone fractures in children and in the detection of fractures extending to the physis. Soft tissue injuries can also be visualized with POCUS. On the other hand, there is moderate agreement between XR and POCUS in the extension of the fracture into the joint, in the detection of dislocations and in SH classification. Keywords: Physis, fracture, children, plain radiography, POCUS
The aim of this thesis study is to demonstrate the effectiveness of Point of Care Ultrasound (POCUS) in the diagnosis of fractures and identification of fracture characteristics in pediatric patients with suspected growth line fracture on physical examination who presented to the emergency department due to trauma and compare it with plain radiography (XR). In this prospective thesis study, children aged 0-18 years who applied to the emergency department due to trauma, who were not in life-threatening condition, whose clinical findings were stable, and who had suspected growth line fractures on physical examination were included. The first physician who evaluated the patients performed POCUS examination and the second physician interpreted the XR images. The presence of fracture, extension to the physis, extension to the joint, angulation, stepping, fracture type, dislocation, and Salter Harris (SH) classification were evaluated in XR and POCUS images. ROC (Receiver operating characteristic) analysis and Kappa (?) value were used to evaluate the accuracy of POCUS compared to XR. The agreement was graded according to the ? magnitude. A ? value greater than 0.75 was considered excellent agreement; between 0.75-0.40 was considered moderate agreement; and below 0.40 was considered poor agreement. 117 patients were included in this study. Fractures were detected in 85 of these patients. Compared to XR, POCUS had a sensitivity of 97% and specificity of 94% in detecting fractures, a sensitivity of 94% and specificity of 96% in detecting physis fractures, and a sensitivity of 60% and specificity of 71% in detecting fractures extending to the joint. Sensitivity was calculated as 100% for angulation, stepping, and adjacent bone fractures. The kappa value of POCUS in the typing of fractures according to XR was 0.881; and in the detection of dislocations, it was 0.742. Of the physis fractures detected on XR, 8 (50%) were SH type II, 3 (19%) were SH type III, and 5 (31%) were SH IV. The kappa value of POCUS compared to XR in SH classification was found to be 0.682. POCUS revealed tissue hematoma in 30 (26%) patients and hemarthrosis in 5 (4%) patients. POCUS has a high sensitivity in the visualization of trauma-related bone fractures in children and in the detection of fractures extending to the physis. Soft tissue injuries can also be visualized with POCUS. On the other hand, there is moderate agreement between XR and POCUS in the extension of the fracture into the joint, in the detection of dislocations and in SH classification. Keywords: Physis, fracture, children, plain radiography, POCUS
Açıklama
04.02.2026 tarihine kadar kullanımı yazar tarafından kısıtlanmıştır.
Anahtar Kelimeler
Acil Tıp, Emergency Medicine
