Abstract
Objectives
To determine the diagnostic accuracy of emergency physician performed point-of care
ultrasound (POCUS) for detecting long bone fractures compared to standard radiography.
Methods
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' 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.
Results
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).
Conclusions
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.
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Article Info
Publication History
Published online: July 29, 2013
Accepted:
June 22,
2013
Received in revised form:
June 21,
2013
Received:
April 30,
2013
Footnotes
☆Meeting abstract presentations: Westerna SAEM; Keystone, Colorado February 2011. National SAEM; Boston, MA, June 2011.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
