Abstract
Objectives
Primary:
To evaluate the diagnostic accuracy of Point of Care Ultrasound for the identification of elbow fractures in paediatric patients.
Methods
We searched MEDLINE, PubMed, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) up until 1st December 2025 for studies involving paediatric patients presenting to the Emergency Department with suspected elbow fractures, who underwent POCUS. Studies were assessed for risk of bias using the QUADAS-2 framework. The primary outcome of interest was the ability of POCUS to accurately detect elbow fractures in terms of sensitivity and specificity.
Results
9 studies were reviewed and included in the meta-analysis encompassing 1444 patients. POCUS demonstrated a sensitivity of 92.7% (95% CI 87.9 % - 95.8%) with a specificity of 84.5% (75.4% – 90.7%). Once sample size was accounted for, the estimated heterogeneity between studies was small. The studies analysed were generally of good quality with the reference standard and flow and timing being the
main areas subject to bias.
Conclusions
The findings of this systematic review and meta-analysis support the conclusion that POCUS is an effective tool in the diagnosis of paediatric elbow fractures presenting to the ED. Given its high sensitivity, a negative POCUS examination may be used to reliably rule out paediatric elbow fractures where the clinical suspicion is low. The moderately high specificity means that positive findings may require confirmatory radiography in cases where clinical findings are less convincing.