Vibration Analysis as a Method for Fracture Screening in Children
Research type
Research Study
Full title
Bone Vibration Analysis as a Novel Screening Tool for Long Bone Fractures in Children
IRAS ID
200673
Contact name
Amaka Offiah
Contact email
Sponsor organisation
Sheffield Childrens NHS Foundation Trust
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Research Summary
When assessing an injured child, doctors must decide whether or not there is an underlying bone fracture. The best way of doing this is to take an x-ray.
In 2011, the 46,000 children attending Sheffield Children’s Hospital Emergency Department had 10,400 x-rays mainly to help diagnose fractures. Taking just the foot and wrist, 2,215 x-rays were normal with no fracture, at a cost of £119,610 for our health community alone (at tariff £54 per x-ray). This works out as a cost of approximately £12 million per year across England and Wales. Additionally, although the radiation dose is quite small, given that x-rays can cause cancer, no radiation is better than some radiation.
A fracture screening method is needed that will help doctors, schoolteachers and others more reliably decide which children should have an x-ray.
Vibration is reliably used in industry to find defects such as cracks in machines and other structures. We believe that vibration can similarly find fractures in bones in children. We have recently demonstrated the ability of vibration to correctly pick 3 out of 13 adults who had a wrist fracture (7 healthy adults and 6 with wrist injury). None of the 7 injured adults felt that vibration would be too painful to use on injured children.
We now propose to compare the vibration patterns of the bones of 100 children over 10 years of age attending our Emergency Department with their fracture positive or fracture negative x-rays.
Should vibration analysis for fracture screening prove sufficiently accurate, we shall carry out further larger studies with the aim of developing an instrument that will reduce the number of injured children having unnecessary x-rays.
This will lead to cost savings for the NHS and less inconvenience for patients and their families, with shorter stays in Emergency Departments and reduced population exposure to harmful ionising radiation.
Summary of Results
Rationale and Hypothesis: Standard practice for differentiating fractures from sprains requires conventional radiographs. Up to 21% of wrist and ankle radiographs in children are negative at a local cost of over £100,000 per annum, approximately £12million per annum across England and Wales. Our recent pilot study in adults confirmed that vibration analysis in injured patients causes no discomfort.
Objectives: To assess the ability of vibration analysis to differentiate sprains from fractures in children presenting to Emergency Departments following wrist or ankle trauma. To assess patient preference for radiographs or vibration.
Methodology: Prospective consent and recruitment of 100 children presenting to a local Emergency Department following wrist or ankle trauma. All were scanned using the vibration analysis technique before standard radiographs were obtained. Analysis of 50 wrist data sets has been completed using median frequency methods without knowledge of the gold-standard radiographic diagnosis. Analysis of the remaining participants has yet to be completed.
Results: Concerning fractures, 22/23 (95.7%) correctly identified. Concerning sprains, 18/27 (66.7%) were correctly identified. Therefore, vibration analysis would have reduced the number of unnecessary radiographs by 67% at a cost saving of £67,000 locally and roughly £8million across England and Wales per annum. However one patient would have been discharged with a fracture. The questionnaire results were as follows: preferred radiographs 13 (26%); preferred vibration 13 (26%); no preference 24 (48%).
Conclusion: Interim data analysis supports the hypothesis that vibration analysis can be used as an effective screening tool for wrist fractures before radiological exposure and warrants larger studies to explore sensitivity, specificity and further applications.REC name
Yorkshire & The Humber - South Yorkshire Research Ethics Committee
REC reference
16/YH/0116
Date of REC Opinion
9 Jun 2016
REC opinion
Further Information Favourable Opinion