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Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers

INTRODUCTION: The goal of this study was to investigate the efficacy of diagnosing shoulder dislocation using a single-view, posterior approach point-of-care ultrasound (POCUS) performed by undergraduate research students, and to establish the range of measured distance that discriminates dislocated...

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Autores principales: Lahham, Shadi, Becker, Brent, Chiem, Alan, Joseph, Linda M., Anderson, Craig L., Wilson, Sean P., Subeh, Mohammad, Trinh, Alex, Viquez, Eric, Fox, John C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899074/
https://www.ncbi.nlm.nih.gov/pubmed/27330675
http://dx.doi.org/10.5811/westjem.2016.2.29290
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author Lahham, Shadi
Becker, Brent
Chiem, Alan
Joseph, Linda M.
Anderson, Craig L.
Wilson, Sean P.
Subeh, Mohammad
Trinh, Alex
Viquez, Eric
Fox, John C.
author_facet Lahham, Shadi
Becker, Brent
Chiem, Alan
Joseph, Linda M.
Anderson, Craig L.
Wilson, Sean P.
Subeh, Mohammad
Trinh, Alex
Viquez, Eric
Fox, John C.
author_sort Lahham, Shadi
collection PubMed
description INTRODUCTION: The goal of this study was to investigate the efficacy of diagnosing shoulder dislocation using a single-view, posterior approach point-of-care ultrasound (POCUS) performed by undergraduate research students, and to establish the range of measured distance that discriminates dislocated shoulder from normal. METHODS: We enrolled a prospective, convenience sample of adult patients presenting to the emergency department with acute shoulder pain following injury. Patients underwent ultrasonographic evaluation of possible shoulder dislocation comprising a single transverse view of the posterior shoulder and assessment of the relative positioning of the glenoid fossa and the humeral head. The sonographic measurement of the distance between these two anatomic structures was termed the Glenohumeral Separation Distance (GhSD). A positive GhSD represented a posterior position of the glenoid rim relative to the humeral head and a negative GhSD value represented an anterior position of the glenoid rim relative to the humeral head. We compared ultrasound (US) findings to conventional radiography to determine the optimum GhSD cutoff for the diagnosis of shoulder dislocation. Sensitivity, specificity, positive predictive value, and negative predictive value of the derived US method were calculated. RESULTS: A total of 84 patients were enrolled and 19 (22.6%) demonstrated shoulder dislocation on conventional radiography, all of which were anterior. All confirmed dislocations had a negative measurement of the GhSD, while all patients with normal anatomic position had GhSD>0. This value represents an optimum GhSD cutoff of 0 for the diagnosis of (anterior) shoulder dislocation. This method demonstrated a sensitivity of 100% (95% CI [82.4–100]), specificity of 100% (95% CI [94.5–100]), positive predictive value of 100% (95% CI [82.4–100]), and negative predictive value of 100% (95% CI [94.5–100]). CONCLUSION: Our study suggests that a single, posterior-approach POCUS can diagnose anterior shoulder dislocation, and that this method can be employed by novice ultrasonographers, such as non-medical trainees, after a brief educational session. Further validation studies are necessary to confirm these findings.
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spelling pubmed-48990742016-06-17 Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers Lahham, Shadi Becker, Brent Chiem, Alan Joseph, Linda M. Anderson, Craig L. Wilson, Sean P. Subeh, Mohammad Trinh, Alex Viquez, Eric Fox, John C. West J Emerg Med Technology in Emergency Medicine INTRODUCTION: The goal of this study was to investigate the efficacy of diagnosing shoulder dislocation using a single-view, posterior approach point-of-care ultrasound (POCUS) performed by undergraduate research students, and to establish the range of measured distance that discriminates dislocated shoulder from normal. METHODS: We enrolled a prospective, convenience sample of adult patients presenting to the emergency department with acute shoulder pain following injury. Patients underwent ultrasonographic evaluation of possible shoulder dislocation comprising a single transverse view of the posterior shoulder and assessment of the relative positioning of the glenoid fossa and the humeral head. The sonographic measurement of the distance between these two anatomic structures was termed the Glenohumeral Separation Distance (GhSD). A positive GhSD represented a posterior position of the glenoid rim relative to the humeral head and a negative GhSD value represented an anterior position of the glenoid rim relative to the humeral head. We compared ultrasound (US) findings to conventional radiography to determine the optimum GhSD cutoff for the diagnosis of shoulder dislocation. Sensitivity, specificity, positive predictive value, and negative predictive value of the derived US method were calculated. RESULTS: A total of 84 patients were enrolled and 19 (22.6%) demonstrated shoulder dislocation on conventional radiography, all of which were anterior. All confirmed dislocations had a negative measurement of the GhSD, while all patients with normal anatomic position had GhSD>0. This value represents an optimum GhSD cutoff of 0 for the diagnosis of (anterior) shoulder dislocation. This method demonstrated a sensitivity of 100% (95% CI [82.4–100]), specificity of 100% (95% CI [94.5–100]), positive predictive value of 100% (95% CI [82.4–100]), and negative predictive value of 100% (95% CI [94.5–100]). CONCLUSION: Our study suggests that a single, posterior-approach POCUS can diagnose anterior shoulder dislocation, and that this method can be employed by novice ultrasonographers, such as non-medical trainees, after a brief educational session. Further validation studies are necessary to confirm these findings. Department of Emergency Medicine, University of California, Irvine School of Medicine 2016-05 2016-04-26 /pmc/articles/PMC4899074/ /pubmed/27330675 http://dx.doi.org/10.5811/westjem.2016.2.29290 Text en © 2016 Lahham et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Technology in Emergency Medicine
Lahham, Shadi
Becker, Brent
Chiem, Alan
Joseph, Linda M.
Anderson, Craig L.
Wilson, Sean P.
Subeh, Mohammad
Trinh, Alex
Viquez, Eric
Fox, John C.
Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers
title Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers
title_full Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers
title_fullStr Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers
title_full_unstemmed Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers
title_short Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers
title_sort pilot study to determine accuracy of posterior approach ultrasound for shoulder dislocation by novice sonographers
topic Technology in Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899074/
https://www.ncbi.nlm.nih.gov/pubmed/27330675
http://dx.doi.org/10.5811/westjem.2016.2.29290
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