of the use of ultrasonography to evaluate lateral malleolar injuries performed the studies. The physicians were asked after performing the ultrasonography whether they believed there was a fracture. Their responses were then compared with the radiologist's interpretation of the radiograph.Results: There were 12 ultrasonographic examinations performed by emergency attending physicians; 8 were interpreted as negative, and none of these had fractures identified on radiograph. Four were interpreted as positive, 3 had fractures identified on radiograph (positive predictive value 75%, negative predictive value 100%, sensitivity 100%, specificity 88.9%). Of the 16 resident ultrasonographic scans, 12 were interpreted as negative; 1 had a fracture identified on radiograph. Four were interpreted as positive, and 3 of these had fractures identified on radiograph (positive predictive value 75%, negative predictive value 91%, sensitivity 75%, specificity 91%).Conclusion: Preliminary results appear to demonstrate good negative predictive value for detection of lateral ankle fractures. Greater numbers are needed to draw conclusions, and this study is ongoing. However, ultrasonography in combination with physical examination may show promise in identifying which patients may forgo radiograph.

Our study gives insufficient evidence to support the use of bedside ultrasound by emergency physicians to rule out appendicitis. The high specificity in our study, however, suggests that with further training, BUSA may be useful to rule-in appendicitis in some patients.

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