Goal-directed ultrasound in the detection of long-bone fractures.
BACKGROUND
New portable ultrasound (US) systems are capable of detecting fractures in the remote setting. However, the accuracy of ultrasound by physicians with minimal ultrasound training is unknown.


METHODS
After one hour of standardized training, physicians with minimal US experience clinically evaluated patients presenting with pain and trauma to the upper arm or leg. The investigators then performed a long-bone US evaluation, recording their impression of fracture presence or absence. Results of the examination were compared with routine plain or computer aided radiography (CT).


RESULTS
58 patients were examined. The sensitivity and specificity of US were 92.9% and 83.3%, and of the physical examination were 78.6% and 90.0%, respectively. US provided improved sensitivity with less specificity compared with physical examination in the detection of fractures in long bones.


CONCLUSIONS
Ultrasound scans by minimally trained clinicians may be used to rule out a long-bone fracture in patients with a medium to low probability of fracture.
Marshburn
Thomas H
TH
Medical Operations, Office of Space Medicine, NASA/Johnson Space Center, Houston, Texas 77058, USA.
Legome
Eric
E
Sargsyan
Ashot
A
Li
Shannon Melton James
SM
Noble
Vicki A
VA
Dulchavsky
Scott A
SA
Sims
Carrie
C
Robinson
David
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards; D004502:Education, Medical, Continuing / Q000592:standards; D004635:Emergency Medicine / Q000193:education / Q000592:standards; D004636:Emergency Service, Hospital; D005188:False Negative Reactions; D005189:False Positive Reactions; D005264:Femoral Fractures / Q000000981:diagnostic imaging*; D006784:Hospitals, Teaching; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging*; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008505:Medical Staff, Hospital / Q000193:education / Q000592:standards; D008875:Middle Aged; D018579:Patient Selection; D010808:Physical Examination / Q000592:standards; D019095:Point-of-Care Systems / Q000592:standards*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods / Q000592:standards