Point‐of‐care bedside ultrasound examination for the exclusion of clinically significant ankle and fifth metatarsal bone fractures; a single blinded prospective diagnostic cohort study

Abstract

Objective The aim of this study was to assess the diagnostic value of point-of-care bedside ultrasound (PoCUS) as in usual clinical practice in suspected ankle and fifth metatarsal bone fractures, compared to the standard of radiographic imaging. Methods This prospective study included patients ≥17 years presenting to the Emergency Department with ankle trauma and positive Ottawa Ankle Rules. All patients underwent PoCUS of the ankle by a (resident) emergency physician, the images were assessed by an ultrasound expert. Both were blinded for the medical history and clinical findings of the patients. Radiography of the ankle followed, evaluated by a radiologist blinded from the PoCUS findings. Primary outcome measures were sensitivity and specificity of PoCUS. Results A total of 242 patients were included, with 35 (22%) clinically significant (non-avulsion) fractures observed with radiography. The sensitivity of PoCUS in detecting clinically significant fractures by all sonographers was 80.0% (95% Confidence Interval (CI) 63.0 to 91.6%), specificity 90.3% (95% CI 83.7 to 94.9%), positive predictive value 70.0% (95% CI 57.0 to 80.3%) and the negative predictive value 94.1% (95% CI 89.1 to 96.9%). The sensitivity of PoCUS in detecting clinically significant fractures by the expert was 82.8% (95% CI 66.3 to 93.4%), specificity 99.2% (95% CI 95.5 to 99.9%), positive predictive value 96.7% (95% CI 80.3 to 99.5%) and the negative predictive value 95.3% (95% CI 91.0 to 98.2%). Conclusion PoCUS combined with the OAR has a good diagnostic value in usual clinical practice in the assessment of suspected ankle and fifth metatarsal bone fractures compared to radiographic imaging. More experience with PoCUS will improve the diagnostic value. Trial registration Registered in the local Research Register, study number 201500597.

Accuracy of ultrasound in diagnosing ankle injuries in emergency care

“…In 10 studies, the reported sensitivity was >90%,8 23 25–32 but the sensitivity varied between 76% (95% CI 63% to 86%) and 100% (95% CI 29% to 100%) among studies (figure 2). In nine studies the reported specificity was at least 91%,8 22–24 26 28 29 31 32 but among all studies varied between 85% (95% CI 74% to 92%) and 100% (95% CI% 88% to 100%).…”

“…A total of 1455 patients in 13 different studies were evaluated for bony injuries 8 21–32. All studies compared US with conventional X-ray (table 1).…”

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What is the diagnostic accuracy of ultrasound versus x-ray for closed metatarsal fractures?

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