title: Novel approach to the diagnosis of fractures in an austere environment using a stethoscope and a cellular phone.
abstract: BACKGROUND
  Fracture diagnosis in the austere environment where radiographic tests are not available can be a challenge. In the past, a diagnostic technique has been described using a tuning fork and stethoscope to assess decreased sound conduction in the fractured extremity. In this study, we evaluate the use of a cellular phone's vibrate function and a stethoscope to limit equipment carried by expeditionary practitioners.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the accuracy of fracture diagnosis using a cellular phone and stethoscope.
  
  
  METHODS
  This is a pilot study to assess the usefulness of the above technique before clinical implementation. In 3 cadavers, we created fractures of the humerus and femur. Twenty-seven emergency medicine residents and an attending physician performed the diagnostic technique.
  
  
  RESULTS
  Overall, the use of the cellular phone and stethoscope resulted in a sensitivity of 73% (95% confidence interval [CI]: 0.64 to 0.81) and a specificity of 83% (95% CI: 0.77 to 0.88), with a positive predicted value of 68% (95% CI: 0.59 to 0.77) and a negative predicted value of 86% (95% CI: 0.81 to 0.90). Positive likelihood ratio was 4.3, and negative likelihood ratio was 0.32.
  
  
  CONCLUSIONS
  The use of a cellular phone and stethoscope may be a useful tool for the diagnosis of fractures in the austere environment. However, further study is needed to validate these findings in the clinical environment.
authors.affiliation: Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX. Electronic address: brett.a.matzek@us.army.mil.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Matzek
authors.affiliation: Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX.
authors.forename: Phillip T
authors.initials: PT
authors.lastname: Fivecoat
authors.affiliation: Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX.
authors.forename: Reis B
authors.initials: RB
authors.lastname: Ritz
mesh_terms: D002102:Cadaver; D040421:Cell Phone; D016001:Confidence Intervals; D004634:Emergency Medical Technicians; D005269:Femur / Q000293:injuries; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D010865:Pilot Projects; D019023:Stethoscopes; D055813:Wilderness Medicine / Q000295:instrumentation / Q000379:methods
keywords: auscultation; austere medicine; combat medicine; diagnosis; fracture; tuning fork; wilderness medicine