Diagnostic accuracy of point-of-care ultrasound in detecting clavicle fractures

• Published in: The American journal of emergency medicine 2025-02, Vol.88, p.156-161
• Main Authors: Haak, Svenja L., Vos, Hendrika, Borgstede, Marion G., Boendermaker, Annemieke E., Rietveld, Vincent, Kroon, Tineke, Rosendaal, Arthur, Lameijer, Heleen, Ter Maaten, Jan C., Stolmeijer, Renate, ter Avest, Ewoud
• Format: Article
• Language: English
• Subjects: Clavicle fracture; POCUS; Ultrasound
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2024.11.008

Point-of-care ultrasound (PoCUS) can be used as a non-invasive and radiation free adjunct in the triage of patients with clavicle injuries. However, the diagnostic accuracy of PoCUS performed by non-radiologists for this purpose is not yet sufficiently established. A multicentre, prospective cohort study was conducted in 8 emergency departments (EDs) to establish the diagnostic accuracy of PoCUS of the clavicle in patients ≥4 years of age who presented with a clavicle injury. PoCUS was performed by trained emergency physicians, and results were compared with X-ray outcomes (gold standard). A total of 167 patients were included, of which 127 (76 %) patients had a fracture on X-ray, and 121 (72 %) on PoCUS. PoCUS of the clavicle had a sensitivity of 93 % (95 %CI 87–97 %), a specificity of 93 % (95 %CI 80–98 %), a negative likelihood ratio of 0.09 (95 %CI 0.04–0.14), and a positive likelihood ratio of 12.39 (95 %CI 4.17–36.82) for the presence of a clavicle fracture. Stratified based on age, specificity of PoCUS was lower in children compared to adults, whereas sensitivity was not affected. The agreement between X-ray and PoCUS for fracture displacement was substantial (κ = 0.771). PoCUS of the clavicle is a useful adjunct in the triage of patients with clavicle injuries and can help to distinguish which patients need further diagnostic workup. Netherlands Trial Register, registration code: NL9236. •After only limited training PoCUS of the clavicle can be performed reliably.•PoCUS has high diagnostic accuracy for exclusion or detection of clavicle fractures.•PoCUS as a diagnostic adjunct can help decide which patients need diagnostic workup.