Ultrasound for management of pediatric nasal fractures

Background: Nasal bone fractures are common in children but can be challenging to diagnose accurately in the first days due to swelling and tenderness. While X-rays and computed tomography have limitations, ultrasound may be a radiation-free and cost-effective alternative for diagnosing and treating nasal fractures. Methods: A prospective cohort study at a tertiary referral hospital between 2021-2023. Children who had sustained nasal trauma were included. A radiologist and a non-radiologist blindly reviewed ultrasound scans, and the results were compared to the physical examination performed by a senior otolaryngologist. If closed reduction was necessary, ultrasound was employed during the procedure. The primary outcome was the assessment of nasal fractures in children using ultrasound; Secondary outcomes included success rates for closed reduction and test reliability. Results: Of the 50 children (mean age: 11 years, interquartile range: 6-15 years, 36 [72%] males), 22 (44%) were clinically diagnosed with a nasal fracture. Interobserver reliability for nasal fracture by ultrasound was 92%, with a Cohen's kappa coefficient of kappa=0.91. The sensitivity and specificity of ultrasound in detecting nasal fractures were 90% and 89%, respectively, with positive and negative predictive values of 86% and 93%, respectively. Closed reduction was performed on 18 children, with (n=11) or without (n=7) ultrasound, with the former showing better alignment results (82% vs. 71%). Conclusions: Ultrasound has a high negative predictive value in identifying nasal fractures in children with swollen noses during presentation. This enables to avoid further unnecessary referrals and interventions. Ultrasound-guided closed reduction of nasal fractures demonstrates improved outcomes; however, further large-scale randomized studies are required to validate our findings.