How Accurate Is Point-of-Care Ultrasound for Detecting Pediatric Elbow Fractures Presenting to the Emergency Department?
Navvya Girdhar, David J. McCreary, Nigel Chan, Adriana Nedyalkova, Jon ReesObjectives:
Primary: To evaluate the diagnostic accuracy of point-of-care ultrasound for the identification of elbow fractures in pediatric patients.
Methods:
We searched MEDLINE, PubMed, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) up until December 1, 2025 for studies involving pediatric patients presenting to the emergency department with suspected elbow fractures, who underwent POCUS. Studies were assessed for risk of bias using the QUADAS-2 framework. The primary outcome of interest was the ability of POCUS to accurately detect elbow fractures in terms of sensitivity and specificity.
Results:
Nine studies were reviewed and included in the meta-analysis encompassing 1444 patients. POCUS demonstrated a sensitivity of 92.7% (95% CI: 87.9%-95.8%) with a specificity of 84.5% (75.4% to 90.7%). Once sample size was accounted for, the estimated heterogeneity between studies was small. The studies analyzed were generally of good quality with the reference standard and flow and timing being the main areas subject to bias.
Conclusions:
The findings of this systematic review and meta-analysis support the conclusion that POCUS is an effective tool in the diagnosis of pediatric elbow fractures presenting to the ED. Given its high sensitivity, a negative POCUS examination may be used to reliably rule out pediatric elbow fractures where the clinical suspicion is low. The moderately high specificity means that positive findings may require confirmatory radiography in cases where clinical findings are less convincing.