The Utility of Emergency Ultrasound for Diagnosing Wrist and Ankle Injuries.
- Author:
Sung Sil LEE
1
;
Dong Un KIM
;
Deuk Hyun PARK
;
Hyun Young CHO
;
Seung Jun AHN
;
Chan Young KHO
;
Tae Yong SHIN
;
Young Sik KIM
;
Young Rock HA
Author Information
1. Department of Emergency Medicine, Bundang Jesaeng General Hospital, Korea. rocky66@dmc.or.kr
- Publication Type:Original Article
- Keywords:
Emergency ultrasound;
Wrist and ankle injury;
Fracture
- MeSH:
Ankle Injuries*;
Ankle*;
Contusions;
Diagnosis;
Disasters;
Emergencies*;
Emergency Medicine;
Extremities;
Humans;
Military Personnel;
Physical Examination;
Prospective Studies;
Radiography;
Radius;
Sensitivity and Specificity;
Transducers;
Ulna;
Ultrasonography*;
Wrist Injuries;
Wrist*
- From:Journal of the Korean Society of Traumatology
2007;20(2):130-137
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Ultrasound is of proven accuracy in abdominal and thoracic trauma and may be useful for diagnosing extremity injury in situations where radiography is not available, such as disasters and military and space applications. However, the diagnosis of fractures is suggested by history and physical examination and is typically confirmed with radiography. As a alternative to radiography, we prospectively evaluated the utility of extremity ultrasound performed by trained residents of emergency medicine (EM) one patient with wrist and ankle extremity injuries. METHODS: Initially, residents of EM performed physical examinations for fractures. The emergency ultrasound (EM US) was performed by trained residents, who used a portable ultrasound device with a 10- to 5-MHz linear transducer, on suspected patients before radiography examination. The results of emergency ultrasound and radiography and the final diagnosis were recorded, and correlations among them were determined by using Kappa`s test. RESULTS: Thirty-nine patients were enrolled in our study. The average age was 36.6+/-19.3 years. There were radius Fx. (n=21), radius-ulna Fx. (n=1), ulna Fx. (n=1), and contusion (n=2) injuries among the wrist injury and lat.-med. malleolar Fx. (n=13), lat. malleolar Fx. (n=6), and med. malleolar Fx. (n=3) injuries among the ankle injury. Comparing EM US with radiography, we found the sensitivity, specificity, positive predictive value, and negative predictive value of EM US for Fx. diagnosis to be 100%, 66.7%, 97.3%, 100% and those of radiography to be 97.2%, 100%, 100%, and 75%, respectively. Kappa`s test for a correlation between the Fx. diagnosis of EM US and the final diagnosis of Fx was performed, and Kappa`s value was 0.787 (P = 0.004). CONCLUSION: EM US for Fx. can be performed quickly and accurately by EM residents with excellent accuracy in remote locations such as disaster areas and in military and aerospace applications. EM US was as useful as radiography in our study and had a high correlation to the final diagnosis of Fx. Therefore, ultrasound should performed on patients with extremity injury to determine whether extremity evaluation should be added to the FAST (focused abdominal sonography trauma) examination.
