Point-of-care bedside ultrasound examination for the exclusion of clinically significant ankle and fifth metatarsal bone fractures; a single blinded prospective diagnostic cohort study

Aniek Crombach*, Nasim Azizi, Heleen Lameijer, Mostafa El Moumni, Jan C. ter Maaten

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    52 Downloads (Pure)

    Abstract

    Objective: The aim of this study was to assess the diagnostic value of point-of-care bedside ultrasound (PoCUS) as in usual clinical practice in suspected ankle and fifth metatarsal bone fractures, compared to the standard of radiographic imaging. Methods: This prospective study included patients ≥17 years presenting to the Emergency Department with ankle trauma and positive Ottawa Ankle Rules. All patients underwent PoCUS of the ankle by a (resident) emergency physician, the images were assessed by an ultrasound expert. Both were blinded for the medical history and clinical findings of the patients. Radiography of the ankle followed, evaluated by a radiologist blinded from the PoCUS findings. Primary outcome measures were sensitivity and specificity of PoCUS. Results: A total of 242 patients were included, with 35 (22%) clinically significant (non-avulsion) fractures observed with radiography. The sensitivity of PoCUS in detecting clinically significant fractures by all sonographers was 80.0% (95% Confidence Interval (CI) 63.0 to 91.6%), specificity 90.3% (95% CI 83.7 to 94.9%), positive predictive value 70.0% (95% CI 57.0 to 80.3%) and the negative predictive value 94.1% (95% CI 89.1 to 96.9%). The sensitivity of PoCUS in detecting clinically significant fractures by the expert was 82.8% (95% CI 66.3 to 93.4%), specificity 99.2% (95% CI 95.5 to 99.9%), positive predictive value 96.7% (95% CI 80.3 to 99.5%) and the negative predictive value 95.3% (95% CI 91.0 to 98.2%). Conclusion: PoCUS combined with the OAR has a good diagnostic value in usual clinical practice in the assessment of suspected ankle and fifth metatarsal bone fractures compared to radiographic imaging. More experience with PoCUS will improve the diagnostic value. Trial registration: Registered in the local Research Register, study number 201500597.

    Original languageEnglish
    Article number19
    Number of pages7
    JournalJournal of foot and ankle research
    Volume13
    Issue number1
    DOIs
    Publication statusPublished - 7-May-2020

    Keywords

    • Point-of-care bedside ultrasound
    • PoCUS
    • Emergency ultrasound
    • Bedside ultrasound
    • Emergency department
    • Ankle fractures
    • Foot fractures
    • RULES
    • ACCURACY
    • FOOT

    Cite this