POCUS for Pulled Elbow Due to Trauma

Introduction: Radial head subluxation (RHS) can result from a traumatic mechanism such as a fall, and these children often receive radiography. Point-of-care ultrasound (POCUS) can identify RHS. Here, we review 2 years of RHS at our facility and show a decrease in length of stay (LOS) for children receiving POCUS. Methods: This is a retrospective chart review at a tertiary care pediatric emergency department (PED). We used keyword searches of our facility’s electronic medical records to identify children treated in the PED for RHS from January 2023 to January 2025. Results: Over the study period, 291 children presented to the PED on 348 occasions with RHS. Of the 348 visits due to RHS, 74 (21%) presented with a traumatic mechanism. Of the 74 children presenting with a history of trauma, 39 (53%) received radiography, versus 22 of 208 (11%) presenting with a history of axial traction and 8 of 66 (12%) presenting with no history. Children with a traumatic mechanism had LOS of 82 minutes versus 62 for children with an axial traction mechanism ( P <0.05). Children with RHS receiving POCUS had an LOS of 61 minutes compared with 103 minutes for children who received radiography ( P < 0.05). When looking specifically at children with a traumatic mechanism, those receiving POCUS only had LOS of 69 minutes versus 92 minutes for children with a traumatic mechanism receiving x-ray ( P < 0.05). Conclusions: Children with RHS frequently present with a history of traumatic injury. POCUS identification of RHS can decrease radiography and LOS in the PED.