scholarly journals P041: Accuracy of medical student-performed point-of-care ultrasound in the diagnosis of distal radius fractures in adults

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S92-S92
Author(s):  
L. Farnell ◽  
A.K. Hall ◽  
C. McKaigney
Keyword(s):  
Medical Students ◽  
Diagnostic Accuracy ◽  
Distal Radius ◽  
Point Of Care ◽  
Distal Radius Fractures ◽  
Point Of Care Ultrasound ◽  
Radiographic Imaging ◽  
Radius Fractures ◽  
Wide Range ◽  
Test Probability

Introduction: Previous investigations of the diagnostic accuracy of point-of-care ultrasound (POCUS) in distal radius fractures (DRF) report a wide range of sensitivities (71%-98%) and specificities (73%-100%) when performed by medical professionals, which may reflect inconsistencies in POCUS training or sonographer experience. The purpose of this study was to determine the accuracy of POCUS performed by pre-clerkship medical students with minimal POCUS training compared to standard radiography in diagnosing DRF in adult patients with traumatic wrist injuries, in order to assess POCUS as an alternative to traditional radiographic imaging. Methods: This prospective observational study was conducted from June to September 2015. The study population consisted of adults presenting to the emergency department (ED) with distal forearm pain secondary to traumatic injury within the past seven days and for whom radiographic imaging was ordered. Patients were evaluated using POCUS performed by medical students with no prior experience who had received one hour of POCUS training taught by an emergency ultrasound fellowship-trained ED physician. A pre-test probability of fracture was stratified as low or high and documented independently by the treating physician. Students were blinded to pre-test probability and radiography results. Results: Of the 52 patients enrolled, 18 had DRF diagnosed by radiographic imaging. Compared to radiography, student-performed POCUS had 72% overall sensitivity (95% CI, 47%-90%) and 85% specificity (95% CI, 69%-95%), with 81% overall accuracy. In the high pre-test probability group (N = 20), POCUS had 80% sensitivity (95% CI, 52%-96%) and 60% specificity (95% CI, 15%-95%). In the low pre-test probability group (N = 32), POCUS had 33% sensitivity (95% CI, 1%-91%) and 90% specificity (95% CI, 73%-98%). Conclusion: POCUS performed by medical students demonstrated reasonable success in diagnosing DRF, with overall sensitivity and specificity in keeping with published data. Within the low pre-test probability group, the diagnostic accuracy of POCUS suggests that ultrasound was an unreliable alternative to radiographic imaging for DRF in this cohort. Future analysis of the factors leading to DRF missed by POCUS as being related to adequacy of POCUS training, image capture, or sonographer experience will further explore the utility of POCUS as a diagnostic alternative.

scholarly journals The diagnostic accuracy of ultrasonography in determining the reduction success of distal radius fractures

2018 ◽  
Vol 18 (3) ◽  
pp. 111-118
Author(s):  
Ozgur Bozkurt ◽  
Murat Ersel ◽  
Funda Karbek Akarca ◽  
Sercan Yalcinli ◽  
Sadiye Midik ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures

scholarly journals Artificial intelligence to diagnosis distal radius fracture using biplane plain X-rays

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kunihiro Oka ◽  
Ryoya Shiode ◽  
Yuichi Yoshii ◽  
Hiroyuki Tanaka ◽  
Toru Iwahashi ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Diagnostic Accuracy ◽  
Distal Radius ◽  
Diagnostic Tests ◽  
Styloid Process ◽  
Final Diagnosis ◽  
Distal Radius Fractures ◽  
X Rays ◽  
Radius Fractures ◽  
X Ray

Abstract Background Although the automatic diagnosis of fractures using artificial intelligence (AI) has recently been reported to be more accurate than those by orthopedics specialists, big data with at least 1000 images or more are required for deep learning of the convolutional neural network (CNN) to improve diagnostic accuracy. The aim of this study was to develop an AI system capable of diagnosing distal radius fractures with high accuracy even when learning with relatively small data by learning to use bi-planar X-rays images. Methods VGG16, a learned image recognition model, was used as the CNN. It was modified into a network with two output layers to identify the fractures in plain X-ray images. We augmented 369 plain X-ray anteroposterior images and 360 lateral images of distal radius fractures, as well as 129 anteroposterior images and 125 lateral images of normal wrists to conduct training and diagnostic tests. Similarly, diagnostic tests for fractures of the styloid process of the ulna were conducted using 189 plain X-ray anteroposterior images of fractures and 302 images of the normal styloid process. The distal radius fracture is determined by entering an anteroposterior image of the wrist for testing into the trained AI. If it identifies a fracture, it is diagnosed as the same. However, if the anteroposterior image is determined as normal, the lateral image of the same patient is entered. If a fracture is identified, the final diagnosis is fracture; if the lateral image is identified as normal, the final diagnosis is normal. Results The diagnostic accuracy of distal radius fractures and fractures of the styloid process of the ulna were 98.0 ± 1.6% and 91.1 ± 2.5%, respectively. The areas under the receiver operating characteristic curve were 0.991 {n = 540; 95% confidence interval (CI), 0.984–0.999} and 0.956 (n = 450; 95% CI 0.938–0.973). Conclusions Our method resulted in a good diagnostic rate, even when using a relatively small amount of data.

scholarly journals LO062: Ultrasound-assisted distal radius fracture reduction

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S51-S52
Author(s):  
S. Socransky ◽  
P.R. Atkinson ◽  
A. Skinner ◽  
M. Bromley ◽  
A. Smith ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Clinical Assessment ◽  
Odds Ratio ◽  
Distal Radius Fractures ◽  
Fracture Reduction ◽  
Radius Fracture ◽  
Point Of Care Ultrasound ◽  
Radius Fractures ◽  
Significant Difference

Introduction: Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of Point-of-care ultrasound (POCUS) to diagnose fractures and guide reduction has previously been described. The primary objective for this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on POCUS following the initial clinical determination of achievement of best possible reduction. Methods: We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to 5 Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically guided reduction, and following each POCUS scan and the post-reduction radiograph. Results: There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment scores for reduction success by PoCUS vs. clinical assessment (Median scores 4 vs.4; p=0.370;) or in the odds ratio of successful reduction (0.89; 95% CI 0.46 to 1.72; p=0.87). Significantly fewer cases fell in the uncertain category with POCUS than with clinical assessment (12 vs 2; p=0.008). Repeat reduction was performed in 49 patients (41.2%). In this group, the odds ratio for adequate reduction assessment post-PoCUS to pre-PoCUS was 12.5 (95% CI 3.42 to 45.7; p<0.0001). There was no significant difference in the assessment of reduction by PoCUS vs. radiograph. Conclusion: PoCUS guided fracture reduction leads to repeat reduction attempts in approximately 40% of cases, and enhances certainty regarding reduction adequacy when clinical assessment is unclear.

The Effect of Volarly Angulated Distal Radius Fractures on Forearm Rotation: In Vitro Biomechanical Study

2015 ◽  
Vol 04 (S 01) ◽  
Author(s):  
Masao Nishiwaki ◽  
Mark Welsh ◽  
Louis Ferreira ◽  
James Johnson ◽  
Graham King ◽  
...  
Keyword(s):  
Distal Radius ◽  
Biomechanical Study ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Forearm Rotation

Pilot Project: Does formal bedside training of medical students with a FAST exam increase their knowledge and comfort level with ultrasound use in a community family medicine practice setting?

POCUS Journal ◽  
2017 ◽  
Vol 2 (2) ◽  
pp. 15-17
Author(s):  
Rimi Sambi, MD ◽  
Heather Sawula, MD ◽  
Brent Wolfrom, MD ◽  
Joseph Newbigging, MD
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Point Of Care ◽  
Training Session ◽  
Undergraduate Curriculum ◽  
Knowledge Retention ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Medical Undergraduate ◽  
Fast Exam

As point of care ultrasound (PoCUS) becomes increasingly popular and a standard of care in many clinical settings, the interest for integration in medical undergraduate curriculum is also growing [1]. This project aims to assess whether formal bedside Focused Abdominal Scan for Trauma (FAST) exam training of medical students increases their knowledge and comfort with the use of bedside ultrasound in a family medicine setting at Queen’s University. Third year medical students (n=18) were recruited to participate in a training session involving a 1-hour online video and 2-hour hands-on session. Knowledge based surveys were completed before and after the training. A survey was completed 4 months after the teaching session evaluating knowledge retention, comfort, and application of skills. Student knowledge of PoCUS and FAST increased and was maintained (pre-training 56%±20%, post-training 82%±10%, p<0.001). Self-evaluation of comfort performing a FAST examination (5-point Likert scale) similarly increased post-training session (pre-training 1.4±0.8, post-training 3.8±0.9, p<0.005), but decreased 4 months later (3±1.2, p<0.005). Students in this study were unanimously interested in ultrasound training and the methods used effectively increased theoretical knowledge and comfort with use. Students did not retain their comfort levels with FAST exam 4 months after the training session, nor did they have the opportunity to utilize the skills learned. Further evidence is required to identify the applicability of these results to undergraduate curriculum development.

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