The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED.

TitleThe accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED.
Publication TypeJournal Article
Year of Publication2013
AuthorsWaterbrook AL, Adhikari S, Stolz U, Adrion C
JournalAm J Emerg Med
Volume31
Issue9
Pagination1352-6
Date Published2013 Sep
ISSN Number1532-8171
KeywordsAdult, Emergency Service, Hospital, Female, Fractures, Bone, Humans, Male, Point-of-Care Systems, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Single-Blind Method
Abstract

<p><b>OBJECTIVES: </b>To determine the diagnostic accuracy of emergency physician performed point-of care ultrasound (POCUS) for detecting long bone fractures compared to standard radiography.</p><p><b>METHODS: </b>This was a single-blinded, prospective observational study of patients presenting to two emergency departments (ED) with trauma to long bones. The study used a convenience sample of patients seen during the study investigators&#39; scheduled clinical shifts. Patients presenting to the ED with complaints of long bone trauma were included in the study when a study investigator was available in the ED. POCUS examinations of injured long bones were performed using a standard protocol. The investigators documented their interpretation prior to radiographs being performed. After standard radiographs were performed, the final radiology reading by a radiology attending physician was obtained from the medical record.</p><p><b>RESULTS: </b>One-hundred six patients were enrolled into the study, and 147 long bone POCUS examinations were performed. Forty-two fractures were present by radiographs and the prevalence of fractures was 29%. The sensitivity was 90.2% (4/41, 95% CI: 76.9-97.3) and specificity was 96.1% (4/102, 95% CI: 90.3-98.9). The positive likelihood ratio was 23.0 (95% CI: 8.8-60.5), and the negative likelihood ratio was 0.102 (95% CI: 0.040, 0.258). The positive predictive value was 90.2% (4/41, 95% CI: 76.9-97.3) and the negative predictive value was 96.1% (4/102, 95% CI: 90.3-98.9).</p><p><b>CONCLUSIONS: </b>Emergency physicians can accurately evaluate long bone fractures in the ED using POCUS. In particular, long bone fractures can be excluded with a high degree of confidence.</p>

DOI10.1016/j.ajem.2013.06.006
Alternate JournalAm J Emerg Med
PubMed ID23891601
Faculty Reference: 
Srikar Adhikari, MD, MS, FACEP
Anna Waterbrook, MD, FACEP
Weight: 
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