US accurate in diagnosing hand injuries

By Amerigo Allegretto, AuntMinnie.com staff writer

May 10, 2021 -- Ultrasound can accurately diagnose hand injuries while also being a fast, inexpensive, and potentially indispensable dynamic tool, according to research published April 29 in Ultrasound in Medicine and Biology.

Examining hand tendon injuries with sonography showed 100% accuracy, sensitivity, and specificity for diagnosing full-thickness hand tendon tears, as well as tenosynovitis of hand flexor tendons, according to a study led by Dr. Chris Nabil Hanna Bekhet from Ain Shams University in Cairo, Egypt.

"It also provides data that are important before diagnostic surgical exploration, and the process consumes less time than traditional wound exploration techniques or MRI," the authors wrote.

Hand and wrist injuries make up 28% of all musculoskeletal injuries and account for 14% to 30% of all patients treated in the emergency department. Tendon injuries are the second most common injuries, within injuries to the flexor tendons having debilitating consequences and high rates of reoperation.

Assessing hand injuries through clinical examination can overlook tendon injuries, and surgeons sometimes opt for explorative surgical methods to detect tendon injuries.

While using ultrasound to examine tendon injuries in the emergency department has its advantages, including eliminating the need for surgical approaches, it is not yet readily adopted by surgeons. This could be because clinicians lack education on how to use ultrasound to resolve clinical questions on the state of the tendon.

The study included 35 patients between September 2018 and January 2020 with trauma to the ventral surface of the hand and wrist who were presented to emergency departments or outpatient clinics. The subjects ranged from 18 to 58 years of age, with 24 patients being male and the other 11 being female.

The researchers examined 50 injured tendons in all flexor hand zones.

On ultrasound examination, 21 of the 50 injured tendons were reported to have complete tears, and 10 tendons were partially torn. The most common cause of injury was cut wounds by sharp objects (20 cases), with injury by a knife as the highest incidence.

In all, ultrasound was found to be statistically significant (p < 0.01) in predicting the surgical findings by correctly identifying the 21 fully lacerated tendons. It was also found to be statistically significant (p < 0.01) in predicting the surgical findings by correctly identifying partially torn tendons and determining the degree of the torn fibers.

The study's limitations included tests being performed by a single operating radiologist and the small sample size.

"More studies in this respect can popularize the technique among radiologists and clinicians," the authors wrote. "Our study also helps anchor the notion that musculoskeletal [ultrasound] could be widely employed for soft tissue structures, with their well-recognized advantages compared with other imaging techniques."

Sonographer vs. radiologist: What does it make?

• MoreBy Amerigo Allegretto, AuntMinnie.com staff writer

May 4, 2021 -- The clinical outcomes of children presenting with suspected acute appendicitis were similar regardless of whether they were scanned by sonographers or radiologists, according to research published April 29 in the Journal of the American College of Radiology.

In a study led by Dr. Leah Gilligan from Northwestern University in Illinois, researchers found that differences between radiologists and sonographers did not lead to clinically important outcomes in children undergoing ultrasound for suspected acute appendicitis. This also includes hospital readmission, surgical consultation, and appendectomy performance.

The team noted that this could also be because clinical care pathways could be sufficiently robust and that deviations in the performance of sonographers or radiologists are corrected by redundant safety nets.

"In other words, although sonographers and radiologists are known to vary in performance and interpretation skill, those differences do not seem to translate into meaningful differences in major clinical care outcomes for this indication," Gilligan colleagues wrote.

The team analyzed 9,283 appendix ultrasound scans with a mean patient age of 9.9 years; 58.2% of the patients were boys. For the study, ultrasound scans were performed by 31 sonographers and interpreted by another 31 radiologists.

The group found no statistically significant difference in outcomes between sonographers and radiologists. For example, children had the same appendectomy rate (20.3%) for both sonographers and radiologists, while the hospital admission frequency was also similar: 34% for sonographers and 33.5% for radiologists.

Despite the differences between sonographers and radiologists not being statistically significant, numerous other clinical and system factors do seem to be associated with these outcomes, the researchers found. Some of these were anticipated, such as ultrasound report impression, degree of abdominal tenderness, and white blood cell count.

One unanticipated factor that researchers noted was whether or not imaging was performed at the main hospital versus a satellite hospital.

They found that presentation to the satellite emergency department was associated with a decreased odds of hospital admission and surgical consultation, as well as an increased odds of hospital readmission within 30 days after adjusting for numerous clinical variables and system factors. The satellite hospital is staffed by the same sonographers and radiologists that work at the main hospital.

"As our study was not primarily designed to specifically investigate the impact of the location of imaging, the exact cause of these differences is unknown," they said.

The team also showed that assessing differences "probably" should not be used as a meaningful quality indicator in radiology department members performing and interpreting appendix ultrasound.

These results are potentially important because appendix ultrasound is widely performed and is a first-line test for suspected appendicitis at most dedicated pediatric hospitals, Gilligan and et al wrote.