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An Algorithmic Approach Using Ultrasonography in the Diagnosis of Pediatric Nasal Bone Fracture

Tamada, Ikkei MD, PhD; Mori, Takaaki MD; Inoue, Nobuaki MD; Shido, Hirokazu MD; Aoki, Marie MD; Nakamura, Yukie MD; Kamogawa, Ruri MD

Journal of Craniofacial Surgery: January 2017 - Volume 28 - Issue 1 - p 84–87
doi: 10.1097/SCS.0000000000003217
Original Articles

Background: Ultrasonography (US) was recently reported as a reliable modality for diagnosing nasal bone fractures. However, whether US is reliable as a screening tool in the pediatric emergency department (ED) remains unknown. This prospective cohort study had a 2-fold aim: to assess the utility of US in the diagnosis of pediatric nasal bone fracture, and to evaluate the validity of our protocol for managing pediatric nasal bone fractures (Fuchu-Kids algorithm).

Patients and Methods: Among the patients who presented at the ED with facial trauma, those with a suspected nasal bone fracture were enrolled in the study. Patients were treated according to Fuchu-Kids algorithm, and the validity of the protocol using US imaging was evaluated.

Results: Among 81 patients who were enrolled during the 1-year study period, 63 patients were able to complete the process described in our protocol for further examination. The diagnostic power of the Fuchu-Kids algorithm had a sensitivity of 91.7%, a specificity of 92.3%, a positive predictive value (PPV) of 88%, and a negative predictive value (NPV) of 94.7%. However, when the performance of US was assessed as a single examination, its sensitivity, specificity, PPV, and NPV were 75%, 92.3%, 85.7%, and 85.7%, respectively.

Conclusion: Using our algorithm, the majority of patients with nasal bone fracture were successfully diagnosed and screened out successfully. Repeated US imaging is effective when clinical symptoms persist even if the first US imaging was negative for nasal bone fracture. However, a detailed medical interview and clinical examination are mandatory, regardless of the use of US.

*Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Children's Medical Center

Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.

Address correspondence and reprint requests to Ikkei Tamada, MD, PhD, Director, Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561, Japan; E-mail:

Received 6 June, 2016

Accepted 23 August, 2016

The authors report no conflicts of interest.

© 2017 by Mutaz B. Habal, MD.