Point-of-Care Ultrasound Used to Diagnose Sternal Fractures Missed by Conventional Imaging.

ABSTRACT: Sternal fractures have often been associated with high-impact thoracic trauma. In children, this is not always the case. X-ray and even computed tomography can miss subtle sternal fractures. Point-of-care ultrasound has been shown to be more sensitive and specific for detecting subtle sternal fractures as compared with plain X-ray. The following 2 cases describe sternal fractures that were missed by traditional imaging modalities, including a fracture missed by chest computed tomography. They also highlight other potential causative mechanisms for sternal fractures in children, including hyperflexion injuries and low-mechanism motor vehicle accidents.

Teaching Point-of-Care Lung Ultrasound to Novice Pediatric Learners: Web-Based E-Learning Versus Traditional Classroom Didactic.

OBJECTIVE: To assess whether Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of pediatric novice learners in the image acquisition and interpretation of pneumothorax and pleural effusion using point-of-care ultrasound (POCUS). METHODS: We conducted a randomized controlled noninferiority study comparing the effectiveness of Web-based teaching to traditional classroom didactic. The participants were randomized to either group A (live classroom lecture) or group B (Web-based lecture) and completed a survey and knowledge test. They also received hands-on training and completed an objective structured clinical examination. The participants were invited to return 2 months later to test for retention of knowledge and skills. RESULTS: There were no significant differences in the mean written test scores between the classroom group and Web group for the precourse test (absolute difference, -2.5; 95% confidence interval [CI], -12 to 6.9), postcourse test (absolute difference, 2.0; 95% CI, -1.4, 5.3), and postcourse 2-month retention test (absolute difference, -0.8; 95% CI, -9.6 to 8.1). Similarly, no significant differences were noted in the mean objective structured clinical examination scores for both intervention groups in postcourse (absolute difference, 1.9; 95% CI, -4.7 to 8.5) and 2-month retention (absolute difference, -0.6; 95% CI, -10.7 to 9.5). CONCLUSIONS: Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of novice learners in POCUS. The usage of Web-based tutorials allows a more efficient use of time and a wider dissemination of knowledge.