364 - Utility of Smart Device Infrared Camera in Localizing Acute Pediatric Long Bone Fractures: Pilot Study

Poster Number: 364
Publication Number: 364.205

Manju M. Korattiyil, University of Texas Southwestern Medical School, Dallas, TX, United States; Jo-ann Nesiama, University of Texas Southwestern Medical School, Coppell, TX, United States; Alessandra Guiner, UT Southwestern Medical Center / Childrens Medical Center Dallas, Dallas, TX, United States; Rong Huang, Children's Medical Center Dallas, Dallas, TX, United States; Rachel Long, UT Southwestern Medical Center, Dallas, TX, United States

Background: Musculoskeletal injuries are one of the top ten reasons children present to the emergency department (ED). This often requires x-rays to determine the presence or absence of fractures. Infrared thermal imaging (infrared thermography, IRT) is a non-invasive and non-radiating imaging modality that uses temperature differences to detect hotter objects. Acutely after a fracture, there is an associated increase in temperature at the site of injury. Therefore, IRT may be used to detect the presence of musculoskeletal injury and potentially limit the amount of x-rays needed, especially in younger patients.

Objective: To assess the utility of a smart device infrared camera attachment’s ability to localize acute pediatric long bone fractures in patients less than 5 years of age.

Design/Methods: This was a prospective cohort study comparing thermal imagery on an injured extremity to the contralateral non-injured extremity. All images were obtained by the PI via an iPad with an infrared camera attachment, while controlling for ambient conditions. Images of the areas of interest were compared with the contralateral extremity of similar region and x-rays taken during the ED visit. Using two different IRT images (Hi/Lo and Span and Level), the area of maximum temperature (Tmax) was identified and compared to x-rays of the injured extremity to determine if there was a possible fracture at the area of Tmax. The PI was blinded to results of the x-rays until after infrared images were obtained.

Results: There was a total of 31 patients enrolled in the study, of which 24 (77.5%) were identified as having fractures and 7 (22.5%) did not have any fracture. Two-thirds of patients were male with a median age of 2 years (IQR, 1.92-3.0) in the fracture group vs 3.0 year (IQR, 2-3.5) in the non-fracture group. Majority of the patients were White in both groups (62.5% and 57.1%), respectively. IRT correctly identified an injury in the fracture group 91.67% of the time, compared to 14.29% in the non-fracture group when using the Span and Level IRT image compared to standard x-rays (p < 0.0002). There was no significant difference in the body part affected between the 2 groups (p=1.00). The temperature difference between the fractured extremity and the non-fractured extremity was not statistically different (p=0.51). Conclusion(s): Smart device Infrared thermography can correctly localize musculoskeletal injuries most of the time. It may be a potential source of fracture localization in children allowing for a decrease in x-rays, which is particularly useful in resource-limited areas.
CV_Korattiyil, ManjuKorattiyil, Manju_CV.pdf