Diagnostic accuracy of point-of-care ultrasound in detecting clavicle fractures

IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE American Journal of Emergency Medicine Pub Date : 2025-02-01 DOI:10.1016/j.ajem.2024.11.008
Svenja L. Haak MD , Hendrika Vos MD , Marion G. Borgstede MD , Annemieke E. Boendermaker MD , Vincent Rietveld MD , Tineke Kroon MD , Arthur Rosendaal MD , Heleen Lameijer MD, PhD , Jan C. Ter Maaten MD, PhD , Renate Stolmeijer MD , Ewoud ter Avest MD, PhD
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Abstract

Study hypothesis

Point-of-care ultrasound (PoCUS) can be used as a non-invasive and radiation free adjunct in the triage of patients with clavicle injuries. However, the diagnostic accuracy of PoCUS performed by non-radiologists for this purpose is not yet sufficiently established.

Methods

A multicentre, prospective cohort study was conducted in 8 emergency departments (EDs) to establish the diagnostic accuracy of PoCUS of the clavicle in patients ≥4 years of age who presented with a clavicle injury. PoCUS was performed by trained emergency physicians, and results were compared with X-ray outcomes (gold standard).

Results

A total of 167 patients were included, of which 127 (76 %) patients had a fracture on X-ray, and 121 (72 %) on PoCUS. PoCUS of the clavicle had a sensitivity of 93 % (95 %CI 87–97 %), a specificity of 93 % (95 %CI 80–98 %), a negative likelihood ratio of 0.09 (95 %CI 0.04–0.14), and a positive likelihood ratio of 12.39 (95 %CI 4.17–36.82) for the presence of a clavicle fracture. Stratified based on age, specificity of PoCUS was lower in children compared to adults, whereas sensitivity was not affected. The agreement between X-ray and PoCUS for fracture displacement was substantial (κ = 0.771).

Conclusions

PoCUS of the clavicle is a useful adjunct in the triage of patients with clavicle injuries and can help to distinguish which patients need further diagnostic workup.

Trial registration number

Netherlands Trial Register, registration code: NL9236.
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即时超声诊断锁骨骨折的准确性。
研究假设:即时超声(PoCUS)可作为一种无创、无辐射的辅助手段用于锁骨损伤患者的分诊。然而,由非放射科医师进行PoCUS诊断的准确性尚未充分确定。方法:在8个急诊科(EDs)进行了一项多中心、前瞻性队列研究,以确定4岁以上锁骨损伤患者锁骨PoCUS的诊断准确性。PoCUS由训练有素的急诊医生进行,并将结果与x线结果(金标准)进行比较。结果:共纳入167例患者,其中x线骨折127例(76%),PoCUS骨折121例(72%)。锁骨PoCUS对锁骨骨折的敏感性为93% (95% CI 87- 97%),特异性为93% (95% CI 80- 98%),阴性似然比为0.09 (95% CI 0.04-0.14),阳性似然比为12.39 (95% CI 4.17-36.82)。根据年龄分层,儿童PoCUS的特异性比成人低,而敏感性不受影响。x线与PoCUS对骨折位移的诊断结果一致(κ = 0.771)。结论:锁骨PoCUS在锁骨损伤患者的分类中是一个有用的辅助手段,可以帮助区分哪些患者需要进一步的诊断检查。试验注册号:荷兰试验登记,注册代码:NL9236。
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来源期刊
CiteScore
6.00
自引率
5.60%
发文量
730
审稿时长
42 days
期刊介绍: A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.
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