The utility of POCUS compared with conventional X-rays in the diagnosis and management of traumatic fractures in paediatric patients: a systematic review

The aim of this review was to assess the utility of point-of-care ultrasound compared with conventional X-ray for the diagnosis and management of traumatic fractures in paediatric patients. A systematic review was conducted in accordance with international guidelines for systematic reviews; the literature search was carried out in PubMed/MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library, considering publications from 2020 to 2026. Studies were included that involved paediatric patients with acute bone trauma, evaluated bedside ultrasound, and used conventional X-ray or computed tomography as the comparator. Methodological quality and risk of bias were assessed using a standardised tool for diagnostic accuracy studies. A total of 16 studies were included, with a cumulative sample size of over 2,700 paediatric patients. The diagnostic sensitivity of ultrasound ranged from 71.5% to 100%, whilst specificity ranged from 82.1% to 97.9%. The best performance was observed in fractures of the distal forearm, whilst paediatric ankle fractures showed the greatest diagnostic variability. Furthermore, ultrasound proved useful in reducing the length of stay in A&E, minimising the need for radiographic examinations and aiding the reduction of certain fractures; it is therefore concluded that point-of-care ultrasound is a useful, rapid and ionising-radiation-free complementary tool, particularly for fractures of the limbs; however, its performance depends on the anatomical location and the operator’s experience; consequently, it does not generally replace conventional X-rays.