Is Bedside Ultrasound a Reliable Method for Detecting Soft Tissue Foreign Bodies in Upper Extremity Penetrating Trauma Patients?

Abstract

Background: Detection of foreign bodies trapped in the soft tissue is a diagnostic problem in patients with penetrating trauma referring to the emergency department. In spite of increasing advances in imaging modalities, detection of foreign bodies trapped in the subcutaneous tissue is still problematic. Among the methods available for the detection of foreign bodies, radiography is the most accessible modality, but it can only diagnose radiopaque objects. CT scan has some limitations including cost and radiation. MRI is very expensive and is not always available. Ultrasound is an easy, inexpensive and accessible method and has no radiation risk. It also provides simultaneous imaging and is bed side available and effective, especially in detection of radiolucent foreign bodies. Objectives: So the new clinical question is that: “Is bedside ultrasound a reliable method for detecting soft tissue foreign bodies in upper extremity penetrating trauma patients?” Patients and Methods: 112 patients with penetrating trauma of volar surface of hand and wrist were enrolled in this study. All patients were clinically suspicious of tendon injury that made them be candidates for diagnostic surgical exploration. Before the surgery, the patients signed a consent form and then a thorough ultrasonography was performed to evaluate the presence of any foreign bodies. The results were then compared with the records of radiography as well as clinical reports of emergency physician and surgeon. Results: Among 112 patients under study, foreign body was detected in 21 patients through clinical examination or surgery, out of which 18 (85.71%) cases were detected by ultrasonography; whereas, radiography was able to detect 16 cases (76.19%). False positive results reported one case (1.1%) in ultrasonography and 0 (0%) in radiography. Conclusions: Ultrasonography seems to be a safe and cost effective method to evaluate foreign bodies, especially radiolucent objects, in patients with penetrating trauma and suspicious of foreign bodies that may remain undiagnosed in radiography. Availability of bedside ultrasound for emergency physicians is an important issue, since it is not possible to access the radiologist at any time of the day and night. On the other hand, treatment of patients in emergency department is a cost-effective way, as it reduces the number of surgical explorations that are merely diagnostic and it is also time and cost-consuming for therapeutic system.