Emergency physician accuracy using ultrasonography to diagnose lateral malleolar fracture

Öztürk, Pınar Aydın; Aksay, Ersin; Oray, Neşe Çolak; Bayram, Başak; Başçı, Onur; Tokgoz, Duygu

doi:10.1016/j.ajem.2017.08.020

Cited by 9 publications

(21 citation statements)

References 9 publications

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“…One meta-analysis from 2017 [208] and two more recent studies [222, 223] all showed high accuracy in detection of fractures in the ankle malleoli. Three studies determined the accuracy of PoCUS specifically for fifth metatarsal fracture, and found total accuracies in the 90s [221, 224, 225].…”

Section: Resultsmentioning

confidence: 99%

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Sorensen¹,

Hunskaar

2019

Ultrasound J

109

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Background: Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services.Methods: Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. Results:On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/ thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. Conclusion:Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Section: Resultsmentioning

confidence: 99%

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Sorensen¹,

Hunskaar

2019

Ultrasound J

109

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“…Additional falsepositive diagnoses, in which sonographic diagnosis of epiphyseal fracture of the lateral malleolus was determined to be no osseous injury according to the followup radiographs, occurred in 2 patients. Both falsepositive and false-negative results have been reported in the sonographic diagnosis of foot and ankle fractures in adults [15,16,30]. The use of Doppler sonography could improve the accuracy because Doppler signals appear around the acute fracture site due to hematoma and increased blood flow [4,32].…”

Section: Discussionmentioning

confidence: 99%

“…With recent improvements in image quality, ultrasonography has been used as a first-line imaging modality for pediatric foot and ankle injuries [14][15][16]. Sonographic examination of ankle trauma can be immediately performed in an outpatient clinic and reduces the need for radiography [14].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of avulsion fractures of the distal fibula after lateral ankle sprain in children: a diagnostic accuracy study comparing ultrasonography with radiography

Takakura¹,

Yamaguchi

Akagi

et al. 2020

BMC Musculoskelet Disord

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Background: The purpose of this study was to determine the diagnostic accuracy of ultrasonography for the diagnosis of avulsion fractures of the distal fibula for lateral ankle sprain in children and compare it to that of radiography. Methods: Children who sustained lateral ankle sprain were prospectively surveyed. They underwent both ultrasonography and radiography at the first clinic visit to diagnose any concomitant avulsion fractures of the distal fibula. The patients underwent follow-up radiography 4 weeks later to obtain the reference standard diagnosis. The measures of diagnostic accuracy (i.e., sensitivity, specificity, positive predictive value, and negative predictive value) of the initial ultrasonography and radiography were calculated; they were then compared using the McNemar test. Totally, 52 patients (with a median age of 9 years) were analyzed. Results: On the reference standard (follow-up) radiographs, 32 patients (62%) were found to have avulsion fractures of the distal fibula. The sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 94, 85, 91, and 89% respectively; and 81, 100, 100, and 77% respectively for radiography at the first visit. There were no significant differences in sensitivity and specificity between the two diagnostic methods (P = 0.22, 0.25). Conclusions: Ultrasonography has a high diagnostic accuracy, which is comparable to that of radiography, for the diagnosis of avulsion fracture of the distal fibula. Ultrasonography may be used as an option of imaging modality for lateral ankle sprain in children.

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“…Although vigorous efforts have been made to delineate the accuracy of US and X-ray for diagnosis of fractures in lower extremities, there is still a great deal of uncertainty regarding their efficacies of calcaneal fractures diagnosis (8,14,17). In most of these studies, the diagnostic sensitivity and specificity of US were found to be similar to plain radiography (18). Lukac et al (4) reported a case of calcaneal fracture detected by US.…”

Section: Discussionmentioning

confidence: 99%

Comparison of diagnostic accuracy of bedside ultrasonography and radiography for calcaneal fractures in the emergency department

Zamani

Mazaheri

Heydari

et al. 2020

J Emerg Pract Trauma

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Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the emergency department (ED) with suspicion of traumatic calcaneus fracture following acute blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by emergency physicians. After that, plain radiography was performed. Furthermore, all the patients were assessed by computed tomography (CT) scan as the gold standard. Results: Finally, 193 patients were enrolled with a mean age of 29.4 ± 15.7 years (85.5% male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7-92.2) and 100% (95% CI, 96.7-100), while the sensitivity and specificity of X-ray were 87.7% (95% CI, 74.5-94.9) and 100% (95% CI, 96.7-100). There was no false positive result for X-ray and US. Conclusion: Our findings suggest that bedside US with an acceptable sensitivity and specificity can be used as a promising alternative for the diagnosis of calcaneal fracture in ED.

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Emergency physician accuracy using ultrasonography to diagnose lateral malleolar fracture

Cited by 9 publications

References 9 publications

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Diagnosis of avulsion fractures of the distal fibula after lateral ankle sprain in children: a diagnostic accuracy study comparing ultrasonography with radiography

Comparison of diagnostic accuracy of bedside ultrasonography and radiography for calcaneal fractures in the emergency department

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