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Advanced Ultrasonic Diagnosis of Extremity Trauma: The FASTER Examination

Dulchavsky, Scott A. MD, PhD; Henry, Scott E. MD; Moed, Berton R. MD; Diebel, Lawrence N. MD; Marshburn, Thomas MD; Hamilton, Douglas R. MD, PhD; Logan, James MD; Kirkpatrick, Andrew W. MD; Williams, David R. MD

Journal of Trauma-Injury Infection & Critical Care:
Original Articles
Abstract

Background : Ultrasound is of proven accuracy in abdominal and thoracic trauma and may be useful for diagnosing extremity injury in situations where radiography is not available such as military and space applications. We prospectively evaluated the utility of extremity ultrasound performed by trained, nonphysician personnel in patients with extremity trauma to simulate remote aerospace or military applications.

Methods : Patients with extremity trauma were identified by history, physical examination, and radiographic studies. Ultrasound examination was performed bilaterally by nonphysician personnel, blinded to radiographic results, with a portable ultrasound device using a 10- to 5-MHz linear probe. Images were videorecorded for later analysis against radiography by Fisher’s exact test.

Results : There were 158 examinations performed in 95 patients. The average time of examination was 4 minutes. Ultrasound accurately diagnosed extremity injury in 94% of patients with no false-positive examinations; accuracy was greater in midshaft locations and least in the metacarpal/metatarsals. Soft tissue/tendon injury was readily visualized.

Conclusion : Extremity ultrasound can be performed quickly and accurately by nonphysician personnel with excellent accuracy. Pulmonary ultrasound appears promising; blinded verification of the utility of ultrasound in patients with extremity injury should be performed to determine whether e xtremity and r espiratory evaluation should be added to the FAST examination (the FASTER examination) and to verify the technique in remote locations such as military and aerospace applications.

Author Information

From the Departments of Surgery (S.A.D., S.H.E., L.N.D.) and Orthopedic Surgery (B.R.M.), Wayne State University School of Medicine, Detroit, Michigan, National Aeronautics and Space Administration, Space and Life Science Directorate, Johnson Space Center (T.M., J.L., D.R.W.), and Wyle Laboratories (D.R.H.), Houston, Texas, and Vancouver General Hospital (A.W.K.), Vancouver, British Columbia, Canada.

Submitted for publication October 12, 2001.

Accepted for publication February 1, 2002.

This work was scheduled for presentation at the 61st Annual Meeting of the American Association for the Surgery of Trauma, which was canceled because of the terrorist attacks of September 11, 2001.

Address for reprints: Scott A. Dulchavsky, MD, PhD, Department of Surgery, Detroit Receiving Hospital, 4201 St. Antoine, Detroit, MI 48201.

© 2002 Lippincott Williams & Wilkins, Inc.