Haak Svenja L, Vos Hendrika, Borgstede Marion G, Boendermaker Annemieke E, Rietveld Vincent, Kroon Tineke, Rosendaal Arthur, Lameijer Heleen, Ter Maaten Jan C, Stolmeijer Renate, Ter Avest Ewoud
Department of Emergency Medicine, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, the Netherlands; Department of Acute Care, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
Department of Emergency Medicine, Wilhelmina Hospital Assen, Europaweg-Zuid 1, 9401 RK Assen, the Netherlands.
Am J Emerg Med. 2025 Feb;88:156-161. doi: 10.1016/j.ajem.2024.11.008. Epub 2024 Nov 17.
Point-of-care ultrasound (PoCUS) can be used as a non-invasive and radiation free adjunct in the triage of patients with clavicle injuries. However, the diagnostic accuracy of PoCUS performed by non-radiologists for this purpose is not yet sufficiently established.
A multicentre, prospective cohort study was conducted in 8 emergency departments (EDs) to establish the diagnostic accuracy of PoCUS of the clavicle in patients ≥4 years of age who presented with a clavicle injury. PoCUS was performed by trained emergency physicians, and results were compared with X-ray outcomes (gold standard).
A total of 167 patients were included, of which 127 (76 %) patients had a fracture on X-ray, and 121 (72 %) on PoCUS. PoCUS of the clavicle had a sensitivity of 93 % (95 %CI 87-97 %), a specificity of 93 % (95 %CI 80-98 %), a negative likelihood ratio of 0.09 (95 %CI 0.04-0.14), and a positive likelihood ratio of 12.39 (95 %CI 4.17-36.82) for the presence of a clavicle fracture. Stratified based on age, specificity of PoCUS was lower in children compared to adults, whereas sensitivity was not affected. The agreement between X-ray and PoCUS for fracture displacement was substantial (κ = 0.771).
PoCUS of the clavicle is a useful adjunct in the triage of patients with clavicle injuries and can help to distinguish which patients need further diagnostic workup.
Netherlands Trial Register, registration code: NL9236.
即时超声检查（PoCUS）可作为锁骨损伤患者分诊中的一种非侵入性且无辐射的辅助检查方法。然而，非放射科医生进行的PoCUS用于此目的的诊断准确性尚未得到充分证实。
在8个急诊科开展了一项多中心前瞻性队列研究，以确定年龄≥4岁的锁骨损伤患者中PoCUS对锁骨的诊断准确性。PoCUS由经过培训的急诊医生进行，结果与X线检查结果（金标准）进行比较。
共纳入167例患者，其中127例（76%）患者X线检查显示骨折，121例（72%）患者PoCUS检查显示骨折。锁骨PoCUS对于锁骨骨折的敏感性为93%（95%CI 87 - 97%），特异性为93%（95%CI 80 - 98%），阴性似然比为0.09（95%CI 0.04 - 0.14），阳性似然比为12.39（95%CI 4.17 - 36.82）。按年龄分层，儿童PoCUS的特异性低于成人，而敏感性不受影响。X线检查与PoCUS在骨折移位方面的一致性较高（κ = 0.771）。
锁骨PoCUS是锁骨损伤患者分诊中的一种有用辅助检查方法，有助于区分哪些患者需要进一步的诊断检查。
荷兰试验注册库，注册号：NL9236。
