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

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.