(P2-72) Diagnostic Accuracy of Bedside Ultrasound for Identifying Fractures in Patients with Orthopedic Trauma Presenting to the Emergency Department of a Level-1 Trauma Center - Aims Ultrasound Fracture Study

Abstract

Background

Radiography is the standard observation tool for examining orthopedic injuries. Bedside Ultrasound (BUS) may be a faster, non-invasive alternative to effectively identify bone fractures in the emergency department (ED) setting. The study compares the diagnostic utilities of BUS and radiography for identifying long bone fractures.

Methods

Prospective observation study with convenience sampling was conducted in ED in patients > 5 years, with post-traumatic upper and lower limb injuries requiring standard radiological examination after informed consent. The BUS examinations were performed by a emergency physician (EP) who had a brief training session to detect fractures. For every subject, radiographs were taken and reviewed for the presence of fracture by blinded orthopedic specialist. Statistical analysis was done by SPSS.

Results

A total of 133 patients were enrolled in the study. Only 42 had fracture, out of which 36 were picked up by BUS. The overall sensitivity of the BUS in detecting fracture was 85.7% with a confidence interval (CI) of 0.70–0.94 and specificity of 100% with a CI = 0.95–1.00. The positive predictive value (PPV) of USG was 100% with a CI = 0.86–1.00 and negative predictive value (NPV) of 93.8% with a CI = 0.86–0.97. There were six additional fractures which were recognized on x-ray and were not picked up by ultrasound.

Conclusions

BUS can be utilized by EP after brief training to accurately identify long-bone fractures. It may gain a more prominent role in pregnant and pediatric population as well as in mass-casualty scenarios.