Ultrasound scanning as a screening method for extremity fractures in adult trauma patients in Emergency Department: A diagnostic study

Objectives: This study was conducted to evaluate the accuracy of ultrasound in comparison with standard X-ray for screening extremities fractures in adult population.

Methods: This was a diagnostic accuracy study performed at the emergency department of Imam Khomeini Complex Hospital, Tehran, Iran. All patients ≥ 18-year-old admitted in the emergency department, with a recent history of trauma including any limb were included. The patients were first evaluated by attending emergency medicine physician using ultrasound and then underwent necessary X-rays. Subsequently, the reports were compared regarding calculating the accuracy.

Results: One hundred twenty-eight patients with the mean age of 37.1 ± 14.9 years enrolled in the study (50.8% were male). The results showed an almost perfect agreement between ultrasound and X ray for detecting upper and lower extremity fractures in studied population (k=0.98). The duration of ultrasound was statistically shorter than X-ray (p<0.0001). The overall sensitivity, specificity and accuracy of ultrasound in detecting fractures were 97.4%, 100%, 99.2% respectively. When considering each bone separately, the lowest sensitivity and accuracy of ultrasound was for femur. Comparing the longitudinal and axial view of ultrasound, longitudinal view was more accurate (p<0.0001).

Conclusions: It is likely that ultrasound could be an accurate and time saving alternative for x-ray in terms of extremities fractures screening in emergency department.