TY - JOUR
T1 - Point-of-care wrist ultrasonography in trauma patients with ulnar-sided pain and instability
AU - Lee, Sun Hwa
AU - Yun, Seong Jong
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/5
Y1 - 2018/5
N2 - Objective: We evaluated the effectiveness of point-of-care wrist ultrasonography compared with 3T-magnetic resonance imaging (MRI) for diagnosing triangular fibrocartilage complex (TFCC) injuries in trauma patients with ulnar-sided pain and instability. Moreover, we assessed the inter-observer variability between an emergency physician and a musculoskeletal radiology fellow. Material and methods: A prospective cross-sectional study was conducted in an emergency department; patients with ulnar-sided sprain and instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the TFC, meniscal homologue, volar and dorsal distal radioulnar ligaments, and extensor carpi ulnaris using point-of-care ultrasonography. Findings were classified as normal, partial rupture, or complete rupture. Wrist 3T-MRI was used as the reference standard. We compared the diagnostic values for point-of-care ultrasonography obtained by both reviewers using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and directly between the two reviewers. Results: Sixty-five patients were enrolled. Point-of-care wrist ultrasonography showed acceptable sensitivity (97.2–99.1%), specificity (96.8–97.3%), and accuracy (96.9–97.9%); these diagnostic performance values did not differ significantly between reviewers (p = 0.58–0.98). Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC = 0.964; musculoskeletal radiology fellow, ICC = 0.976), as was the inter-observer agreement (ICC = 0.968). Conclusion: Point-of-care wrist ultrasonography is as precise as MRI for detecting TFCC injuries, and can be used for immediate diagnosis and further preoperative imaging. Moreover, it may shorten the interval from emergency department admission to surgical intervention while reducing costs.
AB - Objective: We evaluated the effectiveness of point-of-care wrist ultrasonography compared with 3T-magnetic resonance imaging (MRI) for diagnosing triangular fibrocartilage complex (TFCC) injuries in trauma patients with ulnar-sided pain and instability. Moreover, we assessed the inter-observer variability between an emergency physician and a musculoskeletal radiology fellow. Material and methods: A prospective cross-sectional study was conducted in an emergency department; patients with ulnar-sided sprain and instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the TFC, meniscal homologue, volar and dorsal distal radioulnar ligaments, and extensor carpi ulnaris using point-of-care ultrasonography. Findings were classified as normal, partial rupture, or complete rupture. Wrist 3T-MRI was used as the reference standard. We compared the diagnostic values for point-of-care ultrasonography obtained by both reviewers using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and directly between the two reviewers. Results: Sixty-five patients were enrolled. Point-of-care wrist ultrasonography showed acceptable sensitivity (97.2–99.1%), specificity (96.8–97.3%), and accuracy (96.9–97.9%); these diagnostic performance values did not differ significantly between reviewers (p = 0.58–0.98). Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC = 0.964; musculoskeletal radiology fellow, ICC = 0.976), as was the inter-observer agreement (ICC = 0.968). Conclusion: Point-of-care wrist ultrasonography is as precise as MRI for detecting TFCC injuries, and can be used for immediate diagnosis and further preoperative imaging. Moreover, it may shorten the interval from emergency department admission to surgical intervention while reducing costs.
KW - Emergency departments
KW - Magnetic resonance imaging
KW - Triangular fibrocartilage complex
KW - Ultrasonography
KW - Wrist injury
UR - http://www.scopus.com/inward/record.url?scp=85039962064&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2018.01.005
DO - 10.1016/j.ajem.2018.01.005
M3 - Article
C2 - 29307765
AN - SCOPUS:85039962064
SN - 0735-6757
VL - 36
SP - 859
EP - 864
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 5
ER -