Department of Emergency Medicine, Antalya Education and Research Hospital, University of Health Sciences, Antalya 07100, Turkey.
Department of Emergency Medicine, Ercis State Hospital, Van 65400, Turkey.
Medicina (Kaunas). 2019 Jul 9;55(7):355. doi: 10.3390/medicina55070355.
In this study, the accuracy of point-of-care ultrasonography (POCUS) was compared to radiography (XR) in the diagnosis of fractures, the determination of characteristics of the fractures, and treatment selection of fractures in patients admitted to the emergency department (ED) due to trauma and suspected long bone (LB) fractures. The patients were included in the study, who were admitted to ED due to trauma, and had physical examination findings suggesting the presence of fractures in LB (humerus, radius, ulna, femur, tibia, and fibula). The patients were evaluated by two emergency physicians (EP) in ED. The first EP examined LBs with POCUS and the second EP examined them with XR. LBs were evaluated on the anterior, posterior, medial, and lateral surfaces and from the proximal joint to the distal one (shoulder, elbow, wrist, hip, knee, and ankle joint) in both longitudinal and transverse axes with POCUS. A total of 205 patients with suspected LB fractures were included in the study. LB fractures were determined in 99 patients with XR and in 105 patients with POCUS. The sensitivity, specificity, positive predictive value, negative predictive value of POCUS in determining the fractures were 99%, 93%, 93%, and 99%, respectively, compared to XR. Compared to XR, POCUS was able to determine 100% of fissure type fractures (kappa (κ) value: 0.765), 83% of linear fractures (κ: 0.848), 92% of fragmented fractures(κ: 0.756), 67% of spiral fractures (κ:0.798), 75% of avulsion type fractures (κ: 0.855), and 100% of full separation type fractures (κ: 0.855). This study has demonstrated that POCUS has a high sensitivity in diagnosing LB fractures. POCUS has a high sensitivity in identifying fracture characteristics. POCUS can be used as an alternative imaging method to XR in the diagnosis of LB fractures and in the determination of fracture characteristics.
在这项研究中，比较了床边超声（POCUS）与 X 射线（XR）在因创伤而就诊于急诊科（ED）并疑似长骨（LB）骨折的患者中诊断骨折、确定骨折特征以及选择骨折治疗方法的准确性。 研究纳入了因创伤而就诊于 ED 的患者，体格检查发现存在 LB（肱骨、桡骨、尺骨、股骨、胫骨和腓骨）骨折。由两名急诊医师（EP）在 ED 对患者进行评估。第一位 EP 使用 POCUS 检查 LB，第二位 EP 使用 XR 检查 LB。使用 POCUS 从近端关节到远端关节（肩、肘、腕、髋、膝和踝关节）在长轴和横轴上从前、后、内、外表面检查 LB。 共纳入 205 例疑似 LB 骨折患者。在 99 例患者中通过 XR 确定 LB 骨折，在 105 例患者中通过 POCUS 确定 LB 骨折。与 XR 相比，POCUS 确定骨折的灵敏度、特异度、阳性预测值、阴性预测值分别为 99%、93%、93%和 99%。与 XR 相比，POCUS 能够确定 100%的裂隙型骨折（kappa（κ）值：0.765）、83%的线性骨折（κ：0.848）、92%的碎裂型骨折（κ：0.756）、67%的螺旋形骨折（κ：0.798）、75%的撕脱型骨折（κ：0.855）和 100%的完全分离型骨折（κ：0.855）。 本研究表明，POCUS 在诊断 LB 骨折方面具有很高的灵敏度。POCUS 在确定骨折特征方面具有很高的灵敏度。POCUS 可替代 XR 用于诊断 LB 骨折和确定骨折特征。
