Abstract
BackgroundThe aim of the present review is to assess the effectiveness of ultrasound (US) in the detection of upper and lower limb bone fractures in adults compared to a diagnostic gold standard available in secondary and tertiary care centres (e.g. radiography, CT scan or MRI).MethodsThe review followed PRISMA guidelines and used a database-specific search strategy with Medline, EMBASE and The Cochrane Library plus secondary sources (see supplementary material for completed PRISMA checklist). Diagnostic performance of ultrasound was assessed with a qualitative synthesis and a meta-analysis of two data subgroups.ResultsTwenty-six studies were included (n = 2360; fracture prevalence =5.3 % to 75.0%); data were organised into anatomical subgroups, two of which were subjected to meta-analysis. Sensitivity and specificity ranged from 42.11 − 100% and 65.0 − 100%, with the highest diagnostic accuracy in fractures of the foot and ankle. The pooled sensitivity and specificity of US was 0.93 and 0.92 for upper limb fractures (I2 = 54.7 % ; 66.3%), and 0.83 and 0.93 for lower limb fractures (I2 = 90.1 % ; 83.5%).ConclusionUltrasonography demonstrates good diagnostic accuracy in the detection of upper and lower limb bone fractures in adults, especially in fractures of the foot and ankle. This is supported by pooled analysis of upper and lower limb fracture subgroups. Further research in larger populations is necessary to validate and strengthen the quality of the available evidence prior to recommending US as a first-line imaging modality for prehospital use.Trial registrationThe protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017053640.
Highlights
The aim of the present review is to assess the effectiveness of ultrasound (US) in the detection of upper and lower limb bone fractures in adults compared to a diagnostic gold standard available in secondary and tertiary care centres
The aim of the present review is to assess the relative effectiveness of ultrasound in the detection of upper and lower limb fractures in adults compared to the current gold standard for diagnosis (e.g. x-ray, CT scan or MRI)
The authors relied on CT scanning if plain radiography was equivocal [25] or if results were inconsistent between plain x-rays and point-of-care sonography [26]
Summary
The aim of the present review is to assess the effectiveness of ultrasound (US) in the detection of upper and lower limb bone fractures in adults compared to a diagnostic gold standard available in secondary and tertiary care centres (e.g. radiography, CT scan or MRI). The use of ultrasonography in resource-poor settings has been recommended by the World Health Organisation (WHO) as an achievable healthcare goal, with the caveat that its accuracy relies on the skill of the operator [1] This is a significant economic limitation to its deployment, as it requires adequately trained personnel to operate the device and interpret the images. Rationale The focus of trauma ultrasonography has previously been on the validation of the FAST examination in remote settings [3] This technique initially focussed on the imaging of three abdominal windows and has been extended to include a chest examination (eFAST) [3]. It has been widely validated for the timely assessment and triage of haemodynamically unstable abdominal or thoracic trauma patients [4, 5], and is a core component of Advanced Trauma Life Support algorithms worldwide [5]
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