title: The ultrasound identification of simulated long bone fractures by prehospital providers.
abstract: OBJECTIVE
  In austere environments, patient management decisions are often limited by obtainable resources. Portable ultrasound may allow for the detection of fractures when imaging modalities such as radiography are unavailable. We used a simulation training model in a pilot study to examine the ability of emergency medical technicians (EMTs) to detect the presence or absence of a variety of simulated fracture patterns with portable ultrasound.
  
  
  METHODS
  The fracture simulation model is composed of a mechanically fractured bare turkey leg bone housed in a shallow container within a completely opaque gelatin solution. Five different fracture patterns were created. Twenty EMTs sonographically evaluated these models with a portable ultrasound device to determine the presence or absence of a fracture.
  
  
  RESULTS
  EMTs correctly identified the presence or absence of a fracture in the no fracture, transverse fracture, and oblique fracture models 95% of the time. They always correctly identified the presence of a fractured model when assessing the comminuted and segmental fracture models. Across all fracture patterns, a final detection sensitivity of 97.5% (95% confidence interval [CI]: 94.1%-100.0%) and a specificity of 95.0% (95% CI: 85.4%-100.0%) were observed.
  
  
  CONCLUSIONS
  Using portable ultrasound, EMTs correctly detected the presence or absence of simulated long bone fractures with a high degree of sensitivity and specificity. Future studies may evaluate the ability of other groups to use ultrasound to assist in the diagnosis of fractures and examine the clinical impact of this skill in environments where conventional imaging modalities are limited or unavailable.
authors.affiliation: Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA 98431, USA. jasonheiner@hotmail.com
authors.forename: Jason D
authors.initials: JD
authors.lastname: Heiner
authors.forename: Todd J
authors.initials: TJ
authors.lastname: McArthur
mesh_terms: D000818:Animals; D003198:Computer Simulation; D004634:Emergency Medical Technicians / Q000193:education*; D005264:Femoral Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging; D050723:Fractures, Bone / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006801:Humans; D006810:Humeral Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging; D010865:Pilot Projects; D012680:Sensitivity and Specificity; D014422:Turkeys; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods* / Q000592:standards