The following is a summary of “Hip effusions or iliopsoas hematomas on ultrasound in identifying hip fractures in the emergency department,” published in the December 2022 issue of Emergency Medicine by Cohen, et al.
To detect hip fractures in emergency department (ED) patients with a high suspicion of hip fracture, researchers assessed the sensitivity, specificity, predictive values, and likelihood ratios of hip effusion and/or iliopsoas hematoma on point-of-care ultrasound (POCUS) performed by ultrasound fellows and fellowship trained emergency providers.
In two university EDs between 2018 and 2021, a convenience sample of patients with a high suspicion of hip fracture participated in the prospective observational research. Patients with negative x-ray results who did not undergo further imaging with magnetic resonance imaging (MRI) or CT were excluded. The findings of ED imaging and clinical data were hidden from the sonographers. The ultrasonographic exams were carried out at the main location by 4 emergency physicians with emergency ultrasound fellowship training and 8 ultrasound fellows. The ultrasonographic tests were carried out at the secondary location by 2 ultrasound fellows, 4 emergency doctors with emergency ultrasound fellowship training, and 1 emergency provider with sports medicine fellowship training. A hip effusion or an iliopsoas hematoma on the afflicted extremity was considered a favorable ultrasonography result. The most advanced test carried out for each patient was used for comparison, and the primary outcome measures were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of POCUS findings for identification of a hip fracture in comparison with a ranked composite reference standard consisting of x-ray, CT, or MRI.
All of the 213 patients evaluated underwent x-rays, 116 underwent CT scans, and 14 underwent MRIs; 113 of the 213 x-rays (53.1%), 35 of the 116 CT scans (30.2%), and 7 of the 14 MRIs (50.0%) revealed hip fractures. Hip fractures were found in 123 individuals overall (57.7%). Thirteen of the x-ray readings were falsely negative. POCUS had an overall sensitivity of 97% (95% CI: 94%, 100%) compared to the reference standard of x-ray, CT, or MRI, a specificity of 70% (95% CI: 61%, 79%), the positive predictive value of 82% (95% CI: 75%, 88%), and NPV of 94% (95% CI: 88%, 100%) in identifying hip fractures; with a positive likelihood ratio of 3.22 (95% CI: 2.35, 4.43) and negative likelihood ratio of 0.05 (95% CI: 0.02, 0.12).
A hip effusion and/or iliopsoas hematoma on POCUS conducted by skilled emergency ultrasonographers demonstrated great sensitivity in detecting patients with a hip fracture in a convenience sample of ED patients with high clinical suspicion for hip fracture.