Pediatric hand fractures detection on radiographs: do localization cues improve diagnostic performance?,Skeletal Radiology

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Pediatric hand fractures detection on radiographs: do localization cues improve diagnostic performance?
Skeletal Radiology ( IF 1.9 ) Pub Date : 2022-08-19 , DOI: 10.1007/s00256-022-04156-9
Vandan Patel ₁ , Liya Gendler _{2,

3} , Jude Barakat ₄ , Ryan Lim ₄ , Andressa Guariento ₂ , Benjamin Chang _{3,

5} , Jie C Nguyen _{2,

3}

Affiliation

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.

中文翻译：

X 光片上的小儿手部骨折检测：定位线索是否可以提高诊断性能？

客观的

比较使用和不使用定位提示的手部 X 光片检测小儿骨折的诊断准确性和解释时间。

材料和方法

纳入了连续的儿童，他们在受伤后接受了 2 年以上（2019-2021 年）的射线照相检查，并进行了 > 2 周的随访以确认是否存在骨折。四位读者，对病史和诊断不知情，在随机化后至少间隔 1 周，回顾性检查所有图像两次，有无提示，以确定是否存在骨折，如果存在，则记录解剖位置和诊断置信度. 每项研究的解释时间也被记录下来并在读者之间平均。使用 Fleiss 的 kappa 计算读者间协议。使用灵敏度、特异性和 Mann-Whitney U 相关性比较检查之间的诊断准确性和解释时间。

结果

研究组包括 92 名儿童（61 名男孩，31 名女孩；10.8 ± 3.4 岁）和 40 名（31 名男孩，9 名女孩；10.9 ± 3.7 岁）没有骨折。Cue 提高了读者间的一致性（κ = 0.47 至 0.62）。虽然特异性下降（63% 至 62%）、敏感性（75% 至 78%）、诊断准确性（71% 至 73%）和置信度（78% 至 87%，p < 0.01）和解读时间（中位数：40% 至22 秒，p < 0.001) 通过使用定位提示的检查减少。具体而言，有骨折和提示的检查解释时间最短（中位数：16 秒），而无骨折和无提示的检查解释时间最长（中位数：48 秒）。