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- Title
Pediatric hand fractures detection on radiographs: do localization cues improve diagnostic performance?
- Authors
Patel, Vandan; Gendler, Liya; Barakat, Jude; Lim, Ryan; Guariento, Andressa; Chang, Benjamin; Nguyen, Jie C.
- Abstract
Objective: To compare the diagnostic accuracy and interpretation time for detection of pediatric fractures on hand radiographs with and without localization cues. Materials and methods: Consecutive children, who underwent radiographic examinations after injury, over 2 years (2019–2021) and with > 2 weeks of follow-up to confirm the presence or absence of a fracture, were included. Four readers, blinded to history and diagnosis, retrospectively reviewed all images twice, without and with cue, at least 1 week apart and after randomization, to determine the presence or absence of a fracture, and if present, anatomic location and diagnostic confidence were recorded. Interpretation time for each study was also recorded and averaged across readers. Inter-reader agreement was calculated using Fleiss' kappa. Diagnostic accuracy and interpretation time were compared between examinations using sensitivity, specificity, and Mann–Whitney U correlation. Results: Study group included 92 children (61 boys, 31 girls; 10.8 ± 3.4 years) with and 40 (31 boys, 9 girls; 10.9 ± 3.7 years) without fractures. Cue improved inter-reader agreement (κ = 0.47 to 0.62). While the specificity decreased (63 to 62%), sensitivity (75 to 78%), diagnostic accuracy (71 to 73%), and confidence improved (78 to 87%, p < 0.01), and interpretation time (median: 40 to 22 s, p < 0.001) reduced with examinations with localization cue. Specifically, examinations with fracture and cue had the shortest interpretation time (median: 16 s), whereas examinations without fracture and without cue had the longest interpretation time (median: 48 s). Conclusion: Localization cues increased inter-reader agreement and diagnostic confidence, reduced interpretation time in the detection of fractures on pediatric hand radiographs, while maintaining diagnostic accuracy.
- Subjects
PEDIATRICS; HAND injuries; RADIOGRAPHS; DIAGNOSIS of bone fractures; RADIOGRAPHY
- Publication
Skeletal Radiology, 2023, Vol 52, Issue 2, p167
- ISSN
0364-2348
- Publication type
Article
- DOI
10.1007/s00256-022-04156-9