Ultrasonography in assessing suspected bone fractures: a cross-sectional survey amongst German general practitioners

Gordian Lukas Schmid,Thomas Frese,Beatrice Kühnast,Tobias Deutsch,Marcus Heise

doi:10.1186/s12875-020-1078-5

Gordian Lukas Schmid, Thomas Frese + Show 3 more

Open Access

https://doi.org/10.1186/s12875-020-1078-5

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Abstract

BackgroundOver the last two decades, ultrasonography (US) has been shown to be an accurate tool for the diagnosis of suspected bone fractures; however, the integration of this application of US into routine care and outpatient settings needs to be explored. In this study, we surveyed German general practitioners (GPs) to assess their knowledge, attitudes, and utilization of US for the diagnosis of suspected fractures.MethodsNotification of the study, a self-designed questionnaire, and a reminder were mailed to 600 randomly selected GPs in Saxony and Saxony-Anhalt.ResultsThe response rate was 47.7% (n = 286), and respondents did not differ from the population of all GPs in respect to sex and practice type. Among GPs surveyed, 48.6% used an US device in their practice. On average, GPs diagnosed six patients with suspected fractures per month, yet only 39.3% knew about the possibility of ultrasonographic fracture diagnosis, and only 4.3% of GPs using US applied it for this purpose. Among participants, 71.9% believed that US is inferior to conventional X-rays for the diagnosis of bony injuries. Users of US were better informed of and more commonly used US for fracture diagnosis compared to non-users.ConclusionThe need to rule out possible fractures frequently arises in general practice, and US devices are broadly available. Further efforts are needed to improve the knowledge and attitudes of GPs regarding the accuracy of US for fracture diagnosis. Multicenter controlled trials could explore the safety, usefulness, and effectiveness of this still seldom used diagnostic approach for suspected fractures.

Highlights

Over the last two decades, ultrasonography (US) has been shown to be an accurate tool for the diagnosis of suspected bone fractures; the integration of this application of US into routine care and outpatient settings needs to be explored
Addresses were gained from publicly accessible registers, and the contacted General practitioner (GP) were selected from the register using random numbers (n = 400 Saxony, n = 200 SaxonyAnhalt)
Questionnaire The questionnaire was entirely self-designed by the research team, which included two social scientists, a medical student, and two experienced GPs who provided content-related input

Summary

Introduction

Over the last two decades, ultrasonography (US) has been shown to be an accurate tool for the diagnosis of suspected bone fractures; the integration of this application of US into routine care and outpatient settings needs to be explored. Point-of-care US is substantially integrated into health care in hospital and outpatient settings [2]. Accuracy was lower for fractures of the short bones of the hands and feet, as well as fractures in adults. The main advantages of US compared to conventional radiography are no radiation exposure, lower costs [5], and wider availability in non-hospital settings. Evidence suggests US may have higher accuracy than conventional radiographs for certain injuries, such as rib fractures [8] and early scaphoid fractures [9]

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