title: The ability of emergency nurses to detect simulated long bone fractures with portable ultrasound.
abstract: Fractures are a common emergency department (ED) diagnosis. Ultrasound is a useful tool to evaluate for the presence of long bone fractures and can be performed by minimally trained individuals. We examined the ability of ED nurses to sonographically detect long bone fractures using a recently described training model. The fracture model consisted of a turkey long bone within a firm gelatin matrix. Emergency nurses examined five fracture models with a portable ultrasound machine to determine the presence or absence of a fracture. Overall accuracy was compared via chi-square analysis to the ability of physicians to complete the same assessment. Thirty nurses sonographically assessed the models. An overall sensitivity of 98% (95% confidence interval: 92-99%) and specificity of 93% (95% confidence interval: 76-99%) was observed for the detection of a fractured model. No difference in fracture detection accuracy (p>0.05) was revealed compared to an evaluation by 30 ED physicians. While the clinical impact of this ability remains uncertain, future utilization of nursing ability to detect fractures by ultrasound may improve patient care in ways such as more efficient triaging of radiographs and the mobilization of resources for fracture reduction.
authors.affiliation: Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA 98431, United States. jasonheiner@hotmail.com
authors.forename: Jason D
authors.initials: JD
authors.lastname: Heiner
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Proffitt
authors.forename: Todd J
authors.initials: TJ
authors.lastname: McArthur
mesh_terms: D016009:Chi-Square Distribution; D016529:Emergency Nursing / Q000193:education*; D004636:Emergency Service, Hospital; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D019047:Phantoms, Imaging; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D014463:Ultrasonography