Avcı Mustafa, Kozacı Nalan, Beydilli İnan, Yılmaz Fevzi, Eden Arif Onur, Turhan Sadullah
Department of Emergency Medicine,Antalya Education and Research Hospital, Antalya, Turkey.
Department of Emergency Medicine,Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
Am J Emerg Med. 2016 Nov;34(11):2186-2190. doi: 10.1016/j.ajem.2016.08.054. Epub 2016 Aug 27.
The objective of the study was to compare the efficacy of point-of-care ultrasound (POCUS) and computed tomography (CT) in the diagnosis of the fracture of the bones that form the elbow joint and the determination of treatment method in elbow injuries.
Forty-nine patients aged 5 to 65 years, who were admitted with low-energy elbow injuries, had at least 1 fracture of the elbow joint bones, and underwent CT scanning, were included in this study. Before the initiation of the study, orthopedic surgeons and emergency physicians determined a common treatment based on the fracture characteristics. Patients were first evaluated with direct radiography, and then with POCUS by trained emergency physicians. Emergency physicians made treatment decisions based on the ultrasonography results. Then, CT scans were performed. The CT images were interpreted by radiologists. Orthopedic surgeons made treatment decisions based on the CT interpretations.
Forty-nine patients with elbow injury were included in the study. Eighteen (37%) patients were women, and 31 (63%) were men. The mean age was 21 ± 15 years. Compared with CT, sensitivity, specificity, positive predictive value, and negative predictive value of POCUS in fracture detection were 97%, 88%, 94%, and 93%, respectively. Although the sensitivity and specificity of POCUS in the decision for reduction were 95% and 100%, respectively, it was 93% and 100% in the decision for surgery.
In conclusion, POCUS was shown to be successfully applied in the diagnosis and management of elbow injuries, in which direct radiography was inefficient and CT scans were required.
本研究的目的是比较床旁超声（POCUS）和计算机断层扫描（CT）在诊断构成肘关节的骨骼骨折及确定肘部损伤治疗方法方面的疗效。
本研究纳入了49例年龄在5至65岁之间、因低能量肘部损伤入院、肘关节骨骼至少有1处骨折且接受了CT扫描的患者。在研究开始前，骨科医生和急诊科医生根据骨折特征确定了一种通用的治疗方法。患者首先接受直接X线摄影评估，然后由经过培训的急诊科医生进行POCUS检查。急诊科医生根据超声检查结果做出治疗决策。然后进行CT扫描。放射科医生解读CT图像。骨科医生根据CT解读结果做出治疗决策。
本研究纳入了49例肘部损伤患者。18例（37%）为女性，31例（63%）为男性。平均年龄为21±15岁。与CT相比，POCUS在骨折检测中的敏感性、特异性、阳性预测值和阴性预测值分别为97%、88%、94%和93%。尽管POCUS在复位决策中的敏感性和特异性分别为95%和100%，但在手术决策中的敏感性和特异性分别为93%和100%。
总之，POCUS已被证明可成功应用于肘部损伤的诊断和管理，在这种情况下，直接X线摄影效率低下且需要CT扫描。
