Abstract
Objective
In the wilderness and other austere environments, decisions regarding patient management are often limited by obtainable resources. Portable ultrasound may allow for the detection of fractures in areas where other imaging modalities such as radiography are not readily available. We used a simulation training model for the ultrasound diagnosis of long bone fractures to study the ability of emergency medical technicians (EMTs) to detect the presence or absence of a variety of simulated fracture patterns using a portable ultrasound.
Methods
The fracture simulation model is composed of a bare turkey leg bone that is mechanically fractured and housed in a shallow plastic container within a completely opaque gelatin base solution. Five different fracture patterns were created: no fracture, transverse fracture, segmental fracture, oblique fracture, and comminuted fracture. Twenty EMTs then sonographically evaluated these 5 models with a SonoSite M-Turbo portable ultrasound device for the presence or absence of a fracture.
Results
EMTs correctly identified the presence or absence of a fracture in the models with no fracture, a transverse fracture, and an oblique fracture 95% of the time. Participants always correctly identified the presence of a fractured model when assessing the comminuted and segmental fracture model. Across detection of all fracture patterns, a final sensitivity of 97.5% (95% confidence interval [CI]: 94.1%–100.0%) and a specificity of 95.0% (95% CI: 85.4%–100.0%) was observed in our study.
Conclusions
Using a portable ultrasound device, EMTs were able to correctly detect the presence or absence of a simulated long bone fracture with a high degree of sensitivity and specificity. Future studies may further evaluate the ability of other groups to use ultrasound to assist in the diagnosis of fractures, as well as examine the clinical impact of this skill in environments where conventional imaging modalities are limited or unavailable.