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POCUS for Pulled Elbow Due to Trauma: A Retrospective Review and Case Series
Elisheva Arnowitz1, Eric Scheier1,2
1Department of Pediatric Emergency, Kaplan Medical Center, Rehovot.
Insights
Point-of-care ultrasound (POCUS) can identify radial head subluxation (RHS) in children, reducing radiography use and length of stay (LOS) in the pediatric emergency department (PED). This imaging technique is particularly beneficial for children with traumatic injuries.
Area of Science:
- Pediatric Emergency Medicine
- Musculoskeletal Ultrasound
- Radiology
Background:
- Radial head subluxation (RHS) is a common pediatric injury, often resulting from falls or trauma.
- Traditional diagnosis relies on radiography, which may involve radiation exposure and longer wait times.
- Point-of-care ultrasound (POCUS) offers a non-invasive alternative for identifying RHS.
Purpose of the Study:
- To evaluate the impact of POCUS on the diagnosis and management of RHS in a pediatric emergency department.
- To compare the length of stay (LOS) for children diagnosed with RHS using POCUS versus radiography.
- To assess the utility of POCUS in children with RHS, particularly those with a history of traumatic injury.
Main Methods:
- Retrospective chart review of children treated for RHS in a tertiary care pediatric emergency department (PED) from January 2023 to January 2025.
- Identification of cases using electronic medical record keyword searches.
- Comparison of LOS between POCUS and radiography groups, stratified by mechanism of injury.
Main Results:
- A total of 348 RHS visits were analyzed; 74 (21%) involved a traumatic mechanism.
- Children undergoing POCUS had a significantly shorter LOS (61 minutes) compared to those receiving radiography (103 minutes).
- Even in children with traumatic RHS, POCUS led to a decreased LOS (69 minutes) versus radiography (92 minutes).
Conclusions:
- POCUS is an effective tool for diagnosing RHS in children, including those with traumatic injuries.
- Implementing POCUS can significantly reduce radiography utilization and shorten LOS in the pediatric emergency department.
- POCUS represents a valuable advancement in the timely and efficient management of pediatric radial head subluxation.
Introduction:
Radial head subluxation (RHS) can result from a traumatic mechanism such as a fall, and these children often receive radiography. Point-of-care ultrasound (POCUS) can identify RHS. Here, we review 2 years of RHS at our facility and show a decrease in length of stay (LOS) for children receiving POCUS.
Methods:
This is a retrospective chart review at a tertiary care pediatric emergency department (PED). We used keyword searches of our facility's electronic medical records to identify children treated in the PED for RHS from January 2023 to January 2025.
Results:
Over the study period, 291 children presented to the PED on 348 occasions with RHS. Of the 348 visits due to RHS, 74 (21%) presented with a traumatic mechanism. Of the 74 children presenting with a history of trauma, 39 (53%) received radiography, versus 22 of 208 (11%) presenting with a history of axial traction and 8 of 66 (12%) presenting with no history. Children with a traumatic mechanism had LOS of 82 minutes versus 62 for children with an axial traction mechanism ( P <0.05). Children with RHS receiving POCUS had an LOS of 61 minutes compared with 103 minutes for children who received radiography ( P < 0.05). When looking specifically at children with a traumatic mechanism, those receiving POCUS only had LOS of 69 minutes versus 92 minutes for children with a traumatic mechanism receiving x-ray ( P < 0.05).
Conclusions:
Children with RHS frequently present with a history of traumatic injury. POCUS identification of RHS can decrease radiography and LOS in the PED.
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