Bedside fluoroscopy to screen for simple extremity trauma in the ED

Abstract

Portable fluoroscopy units are commonly used by orthopedic surgeons to assist in fracture reduction and immobilization. The purpose of this study was to determine the diagnostic accuracy of bedside fluoroscopy performed by emergency department (ED) physicians to screen for simple extremity trauma. Eligible adult patients presenting to the ED with isolated injuries to distal extremities were evaluated prospectively over a 6-month study period. ED physicians independently performed fluoroscopy at the bedside, obtained real-time images (frontal, lateral, and oblique), and documented their initial interpretations. Patients then underwent routine diagnostic radiographs of the same areas. Fluoroscopic findings (real-time and photographs) were compared with the radiologists' final report. Ninety-two patients with 108 extremity injuries were enrolled in the study. Fractures were diagnosed fluoroscopically in 26 cases, for a sensitivity of 0.70. Of the 71 standard radiographs without a fracture, the fluoroscopic diagnosis was accurate in 66, for a specificity of 0.93. The overall diagnostic accuracy was 0.85, with a 95% confidence interval of .67 to 1.00. There were 11 false-negative fluoroscopic reports, involving the radius (3), distal tibia (3), metacarpals (2), fifth metatarsal (1), phalanx (1), and cuboid (1). These results suggest that bedside fluoroscopy lacks sufficient sensitivity to screen for simple extremity fractures in the ED.