Advanced Ultrasonic Diagnosis of Extremity Trauma: The FASTER Examination

Dulchavsky, Scott A.; Henry, Scott E.; Moed, Berton R.; Diebel, Lawrence N.; Marshburn, Thomas H.; Hamilton, Douglas R.; Logan, James S.; Kirkpatrick, Andrew W.; Williams, David R.

doi:10.1097/00005373-200207000-00006

Cited by 92 publications

(58 citation statements)

References 14 publications

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“…48 In addition to eight articles that had not been published at that time, 20,[26][27][28]32,33,41,46 our study includes thirteen other articles not included in that review. 21,22,24,25,29,30,[34][35][36]38,41,43,44 Additional studies were possibly found as a result of a more comprehensive search strategy. Our review reaches similar conclusions, that PoCUS is a useful tool to supplement radiographs for the detection of fractures.…”

Section: Discussionmentioning

confidence: 99%

“…All studies reported both the sensitivity and specificity of PoCUS, and LRs were calculated from these values when the authors did not include them in their manuscripts. Twenty-five studies 7,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][41][42][43][44] were included, ranging from 26 to 653 patients. Collectively, these studies included 2,982 patients and identified 1,200 fractures, with fracture prevalence ranging from 7% to 71% (aggregate prevalence of 40.2%).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[27][28][29][30] Because they are clinically different, we did not include studies of pediatric or mixed age patients, or studies of patients with mid-shaft lower leg fractures. 35,39,43,44 Forest plots of the included studies' sensitivity and specificity are shown in Figure 5. The studies' pooled test characteristics were as follows: sensitivity 89.5% (95% CI, 77.0%-95.6%), specificity 94.2% (95% CI, 86.1%-97.7%), LR(+ ) 16.4 (95% CI, 6.57-33.5), and LR(-) 0.12 (95% CI, 0.05-0.24).…”

Section: Meta-analysis Of Selected Studiesmentioning

confidence: 99%

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Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

Chartier

Bosco

Lapointe‐Shaw

et al. 2016

CJEM

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Objectives: Long bone fractures (LBFs) are among the most frequent traumatic injuries seen in emergency departments. Reduction and immobilization is the most common form of treatment for displaced fractures. Point-of-care ultrasound (PoCUS) is a promising technique for diagnosing LBFs and assessing the success of reduction attempts. This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs. Data source: MEDLINE and EMBASE databases were searched through July 19, 2015. Study selection: We included prospective studies that assessed test characteristics of PoCUS in 1) the diagnosis or 2) the reduction of LBFs. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data extraction: Thirty studies met inclusion criteria (n = 3,506; overall fracture rate 48.0%). Test characteristics of PoCUS for the diagnosis of LBFs were as follows: sensitivity 64.7%-100%, specificity 79.2%-100%, positive likelihood ratio (LR) 3.11-infinity, and negative LR zero-0.45. Sensitivity and specificity for the adequate reduction of LBFs with PoCUS were 94%-100% and 56%-100%, respectively. PoCUS diagnosis of pediatric forearm fractures in 10 studies showed a pooled sensitivity of 93.1% (95% confidence interval [CI], 87.2%-96.4%) and specificity of 92.9% (95% CI, 86.6%-96.4%), and PoCUS diagnosis of adult ankle fractures in four studies showed a pooled sensitivity of 89.5% (95% CI, 77.0%-95.6%) and specificity of 94.2% (95% CI, 86.1%-97.7%). Conclusion: PoCUS demonstrates good diagnostic accuracy in all LBFs studied, especially in pooled results of diagnosis of pediatric forearm and adult ankle fractures. PoCUS is an appropriate adjunct to plain radiographs for LBFs. RÉSUMÉObjectifs: Les fractures des os longs (FOL) figurent parmi les blessures traumatiques les plus fréquentes au service des urgences, et les traitements les plus courants des fractures avec déplacement consistent en la réduction et l'immobilisation du membre touché. L'échographie au point de service (EPS) est une technique prometteuse dans le diagnostic des FOL et dans l'évaluation de la réussite des tentatives de réduction. Aussi les auteurs ont-ils procédé à un examen exhaustif de la documentation médicale sur l'utilisation de l'EPS dans le diagnostic et la réduction des FOL, et ils font état des résultats dans le présent article. Source de données: Des recherches ont été effectuées dans les bases de données MEDLINE et EMBASE jusqu'au 19 juillet 2015 inclusivement. Sélection des etudes: Ont été retenues des études prospectives visant à évaluer les caractéristiques de fonctionnement de l'EPS au regard 1) du diagnostic ou 2) de la réduction des FOL. La qualité méthodologique des études sélectionnées a été évaluée l'aide de l'outil Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Extraction des données: Trente études respectaient les critères de sélection (n = 3506; taux général de fracture : 48,0 %). Les caractéristiques de fo...

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Meta-analysis Of Selected Studiesmentioning

confidence: 99%

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Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

Chartier

Bosco

Lapointe‐Shaw

et al. 2016

CJEM

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“…As an evolving component of medicine, point of care ultrasound (POCUS) spans across multiple specialties and applications, such as military medical personnel, trauma evaluation, pediatric emergency departments and neonatal intensive care units, and even expanding its utility to aerospace science [1][2][3][4][5][6][7][8]. Recent studies have described POCUS as being easily taught to medical personnel with a high degree of accuracy [1,9,10].…”

Section: Introductionmentioning

confidence: 99%

Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management

et al. 2014

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Background Point of care ultrasound (POCUS) is a useful diagnostic tool in medicine. POCUS provides an easy and reproducible method of diagnosis where conventional radiologic studies are unavailable. Telemedicine is also a great means of communication between educators and students throughout the world. Hypothesis Implementing POCUS with didactics and hands-on training, using portable ultrasound devices followed by telecommunication training, will impact the differential diagnosis and patient management in a rural community outside the United States. Materials and methods This is an observational prospective study implementing POCUS in Las Salinas, a small village in rural western Nicaragua. Ultrasound was used to confirm a diagnosis based on clinical exam, or uncover a new, previously unknown diagnosis. The primary endpoint was a change in patient management. International sonographic instructors conducted didactic and practical training of local practitioners in POCUS, subsequently followed by remote guidance and telecommunication for 3 months. Results A total of 132 patients underwent ultrasound examination. The most common presentation was for a prenatal exam (23.5 %), followed by abdominal pain (17 %). Of the 132 patients, 69 (52 %) were found to have a new diagnosis. Excluding pregnancy, 67 patients of 101 (66 %) were found to have a new diagnosis. A change in management occurred in a total of 64 (48 %) patients, and 62 (61 %) after excluding pregnancy. Conclusion Implementing POCUS in rural Nicaragua led to a change in management in about half of the patients examined. With the appropriate training of clinicians, POCUS combined with telemedicine can positively impact patient care.Keywords Point of care ultrasound Á Rural medicine Á Telemedicine Sommario Background La diagnostica ecografica (POCUS) é un utile strumento diagnostico in medicina. Fornisce un metodo semplice e riproducibile di diagnosi, dove studi radiologici convenzionali non siano disponibili. Anche la telemedicina é un grande mezzo di comunicazione tra docenti e studenti di tutto il mondo. Ipotesi L'implementazione della POCUS con formazione didattica diretta, utilizzando ecografi portatili, seguita da una formazione attraverso la telecomunicazione, avrà un impatto nella diagnosi differenziale e nella gestione del paziente in una comunità rurale fuori degli Stati Uniti. Materiali e Metodi Presentiamo uno studio prospettico sull'implementazione della POCUS a Las Salinas, un piccolo villaggio rurale del Nicaragua occidentale. L'ecografia è stata utilizzata per confermare la diagnosi clinica, o per nuove diagnosi. Il punto primario era un cambiamento nella gestione del paziente. Istruttori internazionali hanno condotto una formazione didattica pratica locale, poi seguita da una guida a distanza con telecomunicazione, per tre mesi. Risultati Un totale di 132 pazienti sono stati sottoposti ad esame ecografico. L'esame più comune era per la diagnostica prenatale (23,5 %), seguito dal dolore addominale (17 %). Dei 132 pazienti, 69 (52 %) h...

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“…Along with others who have suggested nomenclature to describe more ambitious yet standardized resuscitative algorithms, we introduced the extended FAST (EFAST), which is an additional thoracic examination to quickly provide information regarding the presence of hemo/pneumothoraces [8][9][10]. Dulchavsky et al [11] have subsequently described the FASTER examination as the further addition of extremity US to this approach, aimed at improving overall trauma diagnosis in challenging environments.…”

Section: Introductionmentioning

confidence: 99%

Resuscitative Long-Bone Sonography for the Clinician: Usefulness and Pitfalls of Focused Clinical Ultrasound to Detect Long-Bone Fractures During Trauma Resuscitation

Al-Kadi

Gillman

Ball

et al. 2009

Eur J Trauma Emerg Surg

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Bone has one of the highest acoustic densities (AD) in the human body. Traditionally, bone has been considered to be a hindrance to the use of ultrasound (US), as US waves are reflected by the dense matrix and obscure underlying structures. The intense wave reflection, however, can clearly illustrate the cortical bony anatomy of long bones, making cortical disruption obvious. Ultrasound can be used at the bedside concurrently with the overall trauma resuscitation, and may potentially limit the patient's and treating team's exposure to ionizing radiation, corroborate clinical findings, and augment procedural success. The extended focused assessment with sonography for trauma (EFAST) is an essential tool in the resuscitation of severe torso trauma, frequently demonstrating intra- pericardial and intra-peritoneal fluid, inferring hemo/pneumothoraces, and demonstrating cardiac function. Although it is typically considered as a diagnosis of exclusion, multiple long-bone fractures may be a source of shock and can be quickly confirmed at the bedside with EFAST. Further, the early detection of long-bone fractures can also aid in the early stabilization of severely injured patients. Sonographic evaluation for long-bone fractures may be particularly useful in austere environments where other imaging modalities are limited, such as in the battlefield, developing world, and space. While prospective study has been limited, selected series have demonstrated high accuracy among both physician and para-medical clinicians in detecting long-bone fractures. Pitfalls in this technique include reduced accuracy with the small bones of the hands and feet, as well as great reliance on user experience.

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Advanced Ultrasonic Diagnosis of Extremity Trauma: The FASTER Examination

Cited by 92 publications

References 14 publications

Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management

Resuscitative Long-Bone Sonography for the Clinician: Usefulness and Pitfalls of Focused Clinical Ultrasound to Detect Long-Bone Fractures During Trauma Resuscitation

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