Feasibility of emergency department point-of-care ultrasound for rib fracture diagnosis in minor thoracic injury

Lalande, Élizabeth; Guímont, Chantal; Émond, Marcel; Parent, Marc; Topping, Claude; Batomen, Brice; Boucher, Victor J.; Sage, Natalie Le

doi:10.1017/cem.2016.383

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…Pain during patient assessment was the PoCUS technique’s most important (15%) flaw. In the emergency room, PoCUS examination seems to be a reliable method for rib fracture diagnosis 32 .…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, POCUS can be combined with the Ottawa Ankle Rule which are considered as efficient diagnostic tool for assessing ankle and fifth metatarsal bone fractures among 242 patients compared to the plain radiograph 31 . A study evaluating role of POCUS in rib fracture detection among patient with minor thoracic trauma in emergency department revealed higher feasibility along with pain being the primary limiting aspect 32 . POCUS is not only emerging as a promising diagnostic tool in long bone fractures, but also in evaluation of wide variety of fracture characteristics.…”

Section: Discussionmentioning

confidence: 99%

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Comparative use of ultrasound and radiography for the detection of fractures: a systematic review and narrative synthesis

Endara-Mina,

Kumar,

Ghosh

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: Traditionally, X-rays have remained the standard modality for bone fracture diagnosis. However, other diagnostic modalities most notably ultrasound have emerged as a simple, radiation-safe, effective imaging tool to diagnose bone fractures. Despite the advantages, there is a prevalent scarcity of literature recognizing its significance in bone trauma management. This review investigates the effectiveness of ultrasound in the diagnosis of various bone fractures when compared to conventional radiography such as X-rays. Methodology: Electronic databases such as PubMed/Medline, SCOPUS, and Web of Science (WOS) were reviewed for observational studies and review articles from the years 2017–2022 utilizing MESH terminology in a broad term search strategy. The search returned a total of 248 articles. After removal of duplicates, abstract, and full-text screening this systematic review ultimately utilized data from 31 articles. All searches were performed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology and were conducted during August 2022. In accordance with the guidelines for assessing the quality of included systematic reviews, we used the AMSTAR 2020, Supplemental Digital Content 2, http://links.lww.com/MS9/A241 (A Measurement Tool to Assess Systematic Reviews) tool to evaluate the methodological quality of the included studies. A data extraction form based on the Cochrane Consumers and Communication Review group’s extraction template for quality assessment and evidence synthesis was used for data extraction. The information extracted included details such as author information, database, journal details, type of study, etc. Studies included will be classified into long bones, short bones, pneumatic bones, irregular bones, ankle and knee, stress fractures, hip fractures, POCUS, and others. All included studies considered bias and ethical criteria and provided valuable evidence to answer the research question. Results: The search returned a total of 248 articles, with 192 articles remaining after the removal of duplicates. Primary screening of the title and abstract articles from the database search and additional sources identified 68 relevant articles for full-text screening. This systematic review ultimately used data from 33 articles of the remaining articles we included all of them because they had more than 70% certainty, using the STROBE tool for observational articles, narrative reviews with the ENTREQ guide, and systematic reviews and meta-analyses with the PRISMA guide; however, two articles were excluded at the eligibility stage because of risk of bias. Conclusion: This systematic review provides insightful evidence on safety and effectiveness of ultrasound in diagnosing fractures when compared to the conventional imaging modalities such as X-rays. This shall promote further large-scale, multi-centre research that can eventually guide clinic practice in diagnosing and managing various bone fractures.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparative use of ultrasound and radiography for the detection of fractures: a systematic review and narrative synthesis

Endara-Mina,

Kumar,

Ghosh

et al. 2023

Annals of Medicine &Amp; Surgery

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“…Two studies from 2017 used the total cases of positive findings of rib fractures found by either LUS or CXR as the criterion standard (assuming that there were no false-positive findings) and found a sensitivity of 81–98% in LUS compared to 41–53% for CXR [73, 74]. A third study found a similar concordance between LUS and CXR and/or CCT [72].…”

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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“…Three non-English language studies were identified and translated. One study was North American,18 six studies were Asian19–25 and five European 7 26–29. A prospective diagnostic test accuracy study design was used in all but one of the included studies, with Martino et al 29 using a case series design 29…”

Section: Resultsmentioning

confidence: 99%

Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review

et al. 2018

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IntroductionIt is well-recognised that the detection of rib fractures is unreliable using chest radiograph. The aim of this systematic review was to investigate whether the use of lung ultrasound is superior in accuracy to chest radiography, in the diagnosis of rib fractures following blunt chest wall trauma.MethodsThe search filter was used for international online electronic databases including MEDLINE, EMBASE, Cochrane and ScienceDirect, with no imposed time or language limitations. Grey literature was searched. Two review authors completed study selection, data extraction and data synthesis/analysis process. Quality assessment using the Quality Assessment of Diagnostic Accuracy Studies Tool (QUADAS-2) was completed.Results13 studies were included. Overall, study results demonstrated that the use of lung ultrasound in the diagnosis of rib fractures in blunt chest wall trauma patients appears superior compared with chest radiograph. All studies were small, single centre and considered to be at risk of bias on quality assessment. Meta-analysis was not possible due to high levels of heterogeneity, lack of appropriate reference standard and poor study quality.DiscussionThe results demonstrate that lung ultrasound may be superior to chest radiography, but the low quality of the studies means that no definitive statement can be made.

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Feasibility of emergency department point-of-care ultrasound for rib fracture diagnosis in minor thoracic injury

Abstract: PoCUS examination appears to be a feasible technique for a rib fracture diagnosis in the ED.

Cited by 8 publications

References 16 publications

Comparative use of ultrasound and radiography for the detection of fractures: a systematic review and narrative synthesis

Comparative use of ultrasound and radiography for the detection of fractures: a systematic review and narrative synthesis

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

Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review

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