Use of radiography and ultrasonography for nasal fracture identification in children under 18 years of age presenting to the ED

Purpose

To compare the diagnostic value of ultrasonography (USG), which is rapid, inexpensive, simple, and does not involve radiation, with that of direct radiography for identifying fractures in the nasal bones of pediatric patients presenting in the emergency department with nasal trauma.

Equipment and methods

Patients under 18 years old presenting with nasal trauma at the emergency department included prospectively. The patients' age and sex distribution, trauma type, GCS, physical examination findings, direct radiography, and USG results were recorded. The physical examination made by the emergency medicine specialist on arrival was accepted as the gold standard for diagnosis.

Findings

In total, 133 patients, 34.6% female and 65.4% male, were included in this study. The average patient age was 7.44 ± 5.05 years, with the greatest proportion (21.8%, n = 29) of patients in the age ranges of 0–2 and 6–8 years. The most frequently observed finding on physical examinations was swelling (51.1%, n = 68). In total, 50 (37.6%) patients had nasal fractures according to their first physical examination, which was performed by emergency medicine specialists. That is, fractures were detected by direct radiography in only 11 of the 34 cases who were diagnosed with fractures by USG.

Conclusions

We consider that USG should be preferred over direct radiography for use at the bedside of pediatric patients who present at emergency department with nasal trauma, because of its superior diagnostic ability and the lack of a requirement for radiation.