Point-of-Care Ultrasonography by Novice Medical Students for Detecting Fractures in Pediatric Patients with Traumatic Extremity Pain




Tu, Kristie Pham
Pyle, Hunter James

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BACKGROUND: Point of care ultrasound (POCUS) is an important assessment tool to make rapid critical diagnoses in the Emergency Department (ED), including in the evaluation of post-traumatic extremity pain. Several studies have demonstrated the accuracy of medical students performing POCUS examinations after limited training. OBJECTIVE: We aimed to assess the ability of medical students with minimal training in emergency ultrasound to accurately identify bone fractures in patients presenting with traumatic extremity pain. METHODS: Five novice medical students completed a 2 week ultrasound training period consisting of lectures with ultrasound fellowship trained faculty, hands-on practice with bone models, pediatric volunteers, and medical student volunteers (~ 3 hr total training with ~ 9.4 completed bone ultrasounds). Following training, medical students continuously (24 hr / day) recruited pediatric patients presenting to the ED at Children's Medical Center with traumatic extremity pain over 5 weeks. After each ultrasound scan, at least one fellowship trained ultrasound faculty assessed the student's accuracy based on a 1-5 scale established by American College of Emergency Physicians (ACEP). RESULTS: 39 total patients were enrolled in this imaging study. From the student conducted ultrasound scans, 37 were reviewed by Ultrasound fellowship trained faculty. Faculty review revealed that fractures were accurately diagnosed on x-ray at the same location as ultrasound in 16/19 scans (84%, 95% CI, 60-97%), while non-fractures were accurately identified in 17/18 scans (94%, 95% CI, 73-99%). Overall, the students perceived their own diagnostic success in 92% of ultrasound scans, with faculty assessing students' diagnostic success rate at 89%. CONCLUSIONS: Medical students with minimal training can perform ultrasound examinations to accurately identify extremity fractures in pediatric patients. Given the success of teaching novice medical students ultrasound imaging skills, future studies might consider the timeframe / number of standardized scans required for students to obtain accurate scans using ACEP criteria.

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The 58th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 21, 2020, 3-6 p.m., D1.600)

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Tu, K. P., Pyle, H. J., Narayan, A., Jones, J., Bahga, D., Pascual, M., Field, S., . . . Roppolo, L. (2020, January 21). Point of care ultrasonography by novice medical students for detecting fractures in pediatric patients with traumatic extremity pain. Poster session presented at the 58th Annual Medical Students Research Forum, Dallas, TX. Retrieved from https://hdl.handle.net/2152.5/8270

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