Evaluating the Diagnostic Accuracy of Point-of-Care Ultrasound for Long Bone Fractures in the Emergency Department

Long bone fractures are a common emergency department presentation. Conventional radiography, though standard, is limited by accessibility, radiation exposure, and delays. Point-of-care ultrasound (POCUS) provides a rapid, bedside, radiation-free alternative that may enhance diagnostic efficiency.

To evaluate the diagnostic accuracy of POCUS performed by emergency physicians in detecting long bone fractures compared with conventional radiography.

This prospective observational study included a convenience sample of patients of all ages presenting with potential long bone fractures to a tertiary emergency department. Each patient underwent POCUS for fracture with a high-frequency linear probe, followed by plain radiographs as the reference standard. The diagnostic accuracy of POCUS for fracture detection was assessed through calculation of diagnostic parameters. Secondary outcomes included time to diagnosis and physician preference of imaging modality RESULTS: A total of 174 patients included in the analysis. Overall, POCUS detected radiographically-confirmed long bone fractures with a sensitivity of 87.8% (95% CI 81.0-94.6), specificity of 91.7% (95% CI 85.7-97.7), +LR of 10.5 (95% CI 5.2-197 21.7), -LR of 0.13 (95% CI 0.08-0.23), PPV 91.9% (95% CI 86.1-97.7) and NPV of 87.5% (95% CI 80.6-94.4). POCUS provided a significantly faster time to diagnosis than radiography with a mean time of 7.92 ± 2.22 minutes compared to 62.84 ± 23.79 minutes for X-ray (t = 31.194, p < 0.001). Physicians preferred POCUS as the initial imaging modality of choice in a majority of cases (96%).

Compared to plain radiography, POCUS provides a rapid, reasonably accurate, and noninvasive modality for the evaluation of potential long bone fractures. Its efficiency and clinician acceptance support its role as an adjunct in fracture diagnosis, particularly in time-sensitive and resource-limited settings.