Heiner Jason D, Proffitt Aaron M, McArthur Todd J
Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA 98431, United States.
Int Emerg Nurs. 2011 Jul;19(3):120-4. doi: 10.1016/j.ienj.2010.08.004. Epub 2010 Sep 25.
Fractures are a common emergency department (ED) diagnosis. Ultrasound is a useful tool to evaluate for the presence of long bone fractures and can be performed by minimally trained individuals. We examined the ability of ED nurses to sonographically detect long bone fractures using a recently described training model. The fracture model consisted of a turkey long bone within a firm gelatin matrix. Emergency nurses examined five fracture models with a portable ultrasound machine to determine the presence or absence of a fracture. Overall accuracy was compared via chi-square analysis to the ability of physicians to complete the same assessment. Thirty nurses sonographically assessed the models. An overall sensitivity of 98% (95% confidence interval: 92-99%) and specificity of 93% (95% confidence interval: 76-99%) was observed for the detection of a fractured model. No difference in fracture detection accuracy (p>0.05) was revealed compared to an evaluation by 30 ED physicians. While the clinical impact of this ability remains uncertain, future utilization of nursing ability to detect fractures by ultrasound may improve patient care in ways such as more efficient triaging of radiographs and the mobilization of resources for fracture reduction.
骨折是急诊科常见的诊断。超声是评估长骨骨折的有用工具，经过最少培训的人员即可操作。我们使用一种最近描述的培训模型，研究了急诊科护士通过超声检测长骨骨折的能力。骨折模型由置于坚硬明胶基质中的火鸡长骨组成。急诊护士使用便携式超声仪检查了五个骨折模型，以确定是否存在骨折。通过卡方分析将总体准确性与医生完成相同评估的能力进行比较。30名护士对模型进行了超声评估。检测骨折模型时，总体灵敏度为98%（95%置信区间：92-99%），特异性为93%（95%置信区间：76-99%）。与30名急诊科医生的评估相比，骨折检测准确性无差异（p>0.05）。虽然这种能力的临床影响仍不确定，但未来利用护士通过超声检测骨折的能力，可能会以更有效地对X光片进行分诊以及调动骨折复位资源等方式改善患者护理。
