The Role of Ultrasound in the Diagnosis of Pediatric Nasal Fractures.

BACKGROUND: Nasal fractures are the most commonly encountered facial fracture in children presenting to emergency departments. Though plain radiographs have long been used to aid the diagnosis of fractures, its limited diagnostic accuracy has led to the increasing use of ultrasound. Ultrasound offers a cheap, safe, and readily available imaging modality. Evidence in the adult population has shown ultrasound to be far more accurate in identifying nasal fractures. The efficacy of ultrasound in the pediatric setting though remains uncertain. METHODS: A systematic review of the Pubmed and EmBase databases was undertaken. The search terms (nose OR nasal) AND (fracture) AND (ultrasound OR ultrasonography OR sonography) and associated MeSH terms were searched. The search was limited to those <18 years of age. RESULTS: Following review and exclusion, 3 papers met the inclusion criteria. All 3 studies showed ultrasound was able to detect nasal fractures in children. Two studies showed that ultrasound diagnosed fractures with a greater accuracy than plain radiographs. One study used ultrasound alone and reported a sensitivity of 75% and specificity as 92.3%. CONCLUSION: With the limited evidence to date in the pediatric population, ultrasound appears to offer a more accurate radiological investigation in nasal fractures. It could be considered diagnostically superior to plain radiographs and reduces radiation exposure in children. Further work is required to better determine its true utility and improve its diagnostic accuracy.

Is constipation a trivial matter?

Constipation is a common symptom of patients presenting to the emergency department. If poorly managed, it can have significant consequences. A 50-year-old man was admitted to the emergency department following cardiac arrest. His medical history included a diagnosis of cerebral palsy and multiple admissions to hospital with constipation. Clinical examination revealed a grossly distended and tense abdomen. Circulatory supply to the lower limbs was acutely impaired. CT scan revealed massive dilation of the large bowel due to faecal loading with compromised circulation to the lower limbs. Despite aggressive attempts at resuscitation, the patient continued to deteriorate and passed away. On reflection, a diagnosis of abdominal compartment syndrome secondary to severe constipation was made. This case highlights the vigilance required when managing what is often felt to be a trivial complaint and the considerable consequences when there is a failure to do so.