Ultrasound in Elbow Fractures.

Avci et al published in the American Journal of EmergencyMedicine findings of their study of point-of-care ultrasound (POCUS) and computed tomography (CT) for patients presenting with elbow injuries in emergency departments. 

The authors examined 49 patients aged 5 to 65 years, who had at least 1 fracture of the elbow joint bones, and underwent CT scanning in emergency room. Patients were first evaluated with direct radiography, and then with POCUS by trained emergency physicians. Emergency physicians made treatment decisions based on the ultrasonography results. Then, CT scans were performed and were interpreted by radiologists. Orthopedic surgeons made treatment decisions based on the CT interpretations.

Of the 49 patients with elbow injury were included in the study 18 (37%) were women, and 31 (63%) were men. Compared with CT, sensitivity, specificity, positive predictive value, and negative predictive value of POCUS in fracture detection were 97%, 88%, 94%, and 93%, respectively. Although the sensitivity and specificity of POCUS in the decision for reduction were 95% and 100%, respectively, it was 93% and 100% in the decision for surgery.

The authors concluded that POCUS is effective in the diagnosis and management of elbow fractures when direct radiology is inconclusive and CT is required.

Rising Utilization of CT in Adult Fall Patients

Brinjikji et al in an article published by the AmericanJournal of Roentgenology report on the CT utilization for adult patients secondary to falls in the United States.

Using the National Hospital Ambulatory Medical Care Survey, they identified all visits from 2001 to 2010 of adult patients presenting to EDs after falls. This database surveys approximately 500 EDs annually for 4 weeks, providing national estimates on ED resource utilization and outcomes. They studied trends in CT utilization and proportion of visits with life-threatening conditions (intracranial hemorrhage, organ laceration, axial skeletal fractures) after falls.

Their study looked at 22,166 cases representing 73,241,368 visits in Emergency Departments. The proportion of adult fall patient visits during which CT was performed increased from 11.4% in 2001 to 28.0% in 2010 (p < 0.0001), whereas the proportion of adult fall visits with life-threatening conditions increased from 5.7% to 8.2% (p < 0.0001).  The odds of CT utilization in 2010 compared with 2001 were 2.62 (95% CI, 2.61–2.62).

They concluded that there was a significant increase in CT utilization among adult fall patient visits from 2001 to 2010.  Their findings suggest that CT is overused among adults who have fallen.

iPad is Accurate in the Diagnosis of Pediatric Pneumonias

In the 51^st annual meeting of the European Society of Pediatric Radiology in Amsterdam, Papaioannou et al from Mitera Hospital in Athens, and Ohio State University in Columbus , Ohio presented their findings regarding the accuracy and usefulness of the iPad in the diagnosis of pneumonias in neonates and infants.

The chest x-rays of 99 consecutive cases were retrospectively evaluated. Findings included consolidation (19), patchy densities/air-space shadowing (7), diffuse air-space shadowing (4), bilateral peribronchial thickening (18), peribronchial thickening and consolidation (4), RLL Hyperinflation (1), patchy hyperlucencies (2) and coarse pattern (2). The images were anonymized and distributed after randomization to two experienced pediatric attending radiologists and two fellows. Diagnostic monitors and a non-retina display iPad2 device were used for viewing the studies.

On the diagnostic monitors, the correct/incorrect ratio was 139/59 for the attendings and 137/61 for fellows. On the iPad, it was 141/57 and 150/48 respectively. In the detection of lung disease, the iPad sensitivity was 79.8%, specificity 64.9%, PPV 5.5% and NPV 70.3%. As a group the attendings and fellows correct/incorrect ratio was 276/120 on the monitors and 291/105 on the iPad. There was no difference in the accuracy of interpretation or the performance depending on the device used among attendings and fellows.

The authors concluded that although diagnostic monitors will continue to be the device of choice in Radiology departments, mobile tablets will play an increasingly important role in the radiographic detection of lung disease in neonates and infants in the intensive care units, emergency department and/or for teleradiology purposes.

John Spigos, BS