I have to say, I’m a little confused by all the new SonoSite television ads – direct-to-consumer marketing for sports medicine ultrasonography? Or for zero-complication central line placement? Weird.
But, I digress. A little. This is a pediatric study of lightly trained ultrasonographers with varying levels of expertise using ultrasound to diagnose long-bone fractures. They performed 98 ultrasound examinations that were followed up by plain radiography, and they picked up 41 of the 43 fractures present, with 8 false positives: 95% sensitivity and 85% specificity. Six required reduction, all of which were identified as meeting criteria for reduction on ultrasound – as well as one additional false positive from a distal radius fracture.
As a feasibility study, it’s a nice little pilot. As a practice-changing strategy, it needs larger sample sizes and external validity. However, it does seem as though it will soon become reasonable to use bedside ultrasound to quickly rule-out fracture in patients with a low pre-test probability, while plain radiography will continue to play a role in advanced orthopedics management.
“Emergency Ultrasound in the Detection of Pediatric Long-Bone Fractures”
www.ncbi.nlm.nih.gov/pubmed/23114237