title: The accuracy of portable ultrasonography to diagnose fractures in an austere environment.
abstract: BACKGROUND
  Previous literature has shown the ability of ultrasonography technology to accurately assess orthopedic pathology. Over the past two decades, the use of ultrasound in the prehospital setting has become an important tool for triage, diagnosis, and treatment, especially in austere and remote environments that lack appropriate radiography capability and logistical support. The purpose of our study was to assess the accuracy of ultrasound in the austere, combat environment for diagnosis of orthopedic fracture.
  
  
  METHODS
  We conducted a longitudinal, prospective, observational study on patients presenting with suspected closed fractures using a digital handheld ultrasound device. All patients presenting with suspected fracture underwent an ultrasound examination by a board-certified emergency medicine physician credentialed in emergency ultrasonography. Patients were then categorized into ultrasound-positive and ultrasound-negative groups.
  
  
  RESULTS
  A total of 44 subjects underwent ultrasound examination for suspected fractures. There were initially 12 (27%) positive and 32 (73%) negative scans. Of the initial 12 positive scans, ten had a true fracture verified by plain radiography. Ultrasonography yielded an overall sensitivity of 100% and a specificity of 94%. Only four patients with an initial negative ultrasound scan continued to have clinical symptoms for more than three days and were found to have no evidence of fracture by radiograph.
  
  
  CONCLUSIONS
  Our data show that use of ultrasound by an experienced clinician in the austere environment can be performed accurately and can possibly prevent unnecessary evacuations for suspected fractures requiring radiographic verification. The purpose of our study was to assess the accuracy of ultrasound examination in the austere, combat environment for diagnosis of orthopedic fracture.
authors.affiliation: Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas 78234-6315, USA. john.mcmanus@amedd.army.mil
authors.forename: Christopher R
authors.initials: CR
authors.lastname: McNeil
authors.forename: John
authors.initials: J
authors.lastname: McManus
authors.forename: Sumeru
authors.initials: S
authors.lastname: Mehta
mesh_terms: D004632:Emergency Medical Services; D005596:Fractures, Closed / Q000000981:diagnostic imaging*; D006801:Humans; D008137:Longitudinal Studies; D008889:Military Personnel; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014218:Triage; D014463:Ultrasonography / Q000295:instrumentation