Hip Fractures (i.e. Femoral Neck or Intertrochanteric Hip Fractures)
Conditions
Keywords
femoral neck, pertrochanteric, hip, fracture, POCUS, ultrasound, diagnostic, Emergency Department, proximal femur
Brief summary
Hip (femoral neck and pertrochanteric) fractures account for a significant part of Emergency Department (ED) visits after trauma. Studies suggest that point-of-care ultrasound (POCUS) is a reliable diagnostic tool for fracture assessment. POCUS has several advantages over conventional radiography, such as being portable, cheaper and radiation free. In addition, immediate conversion to ultrasound guided regional anaesthesia upon diagnosis of fracture can improve patient's time to proper analgesia. Moreover, POCUS can potentially be used pre-hospital to rule out hip fractures reducing ED crowding, as well as being a solution for areas where radiography is not readily available (e.g. rural or developing areas). The primary objective of this study, is to evaluate the diagnostic capabilities of POCUS regarding patients with suspected hip fracture after trauma compared to radiography, the current standard of care diagnostic tool.
Detailed description
Rationale: Hip (femoral neck and pertrochanteric) fractures account for a significant part of Emergency Department (ED) visits after trauma. Studies suggest that point-of-care ultrasound (POCUS) is a reliable diagnostic tool for fracture assessment. POCUS has several advantages over conventional radiography, such as being portable, cheaper and radiation free. In addition, immediate conversion to ultrasound guided regional anaesthesia upon diagnosis of fracture can improve patient's time to proper analgesia. Moreover, POCUS can potentially be used pre-hospital to rule out hip fractures reducing ED crowding, as well as being a solution for areas where radiography is not readily available (e.g. rural or developing areas). Objective: Our primary objective is to evaluate the diagnostic capabilities of POCUS regarding patients with suspected hip fracture after trauma compared to radiography, the current standard of care diagnostic tool. Study design: Prospective cohort study. Study population: All patients aged 18 and older presenting to the ED with a painful hip after trauma suspected of hip fracture are eligible to be enrolled in this study. Intervention: Patients enrolled in the study will undergo POCUS of the hip (femoral neck) by the (resident) emergency physician, prior to radiograph imaging. Main study parameters/endpoints: Sensitivity, specificity, positive predicting value (PPV) and negative predicting value (NPV) of POCUS in detecting hip fractures by assessing for posttraumatic changes (cortical disruptions, joint effusion and peritrochanteric edema). Informed consent will be requested and documented.
Interventions
DIAGNOSTIC_TESTPOCUS of the hip
POCUS of the hip (proximal femur) by the (resident) emergency physician, prior to radiograph imaging.
Sponsors
Frisius Medisch Centrum
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ≥18 years of age * presenting to the ED with a painful hip after trauma, suspected of hip fracture as defined by the attending clinician
Exclusion criteria
* History of hip fracture or surgical procedure on the bones of the ipsilateral hip (ultrasound images may be unreliable) * Presence of foreign body material in the ipsilateral hip * Skin defects at the POCUS site e.g. lacerations, infected skin * Extensive injuries, extreme pain or neurovascular damage where urgent intervention is required * Inability to give informed consent (cognitive impairments, no proficient understanding of the Dutch or English language)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic accuracy of POCUS | From enrollment to the end of POCUS, approximately 10 to 30 minutes | Diagnostic accuracy (sensitivity, specificity, negative predicting value (NPV) and positive predicting value (PPV)) of POCUS in detecting hip fractures by assessing for posttraumatic changes (cortical disruptions, joint effusion and peritrochanteric edema). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Difference in diagnostic accuracy of POCUS in diagnosing a femoral neck or pertrochanteric fracture | From enrollment to the end of POCUS, approximately 10 to 30 minutes | Difference in diagnostic accuracy (sensitivity, specificity, negative predicting value (NPV) and positive predicting value (PPV)) of POCUS in diagnosing a femoral neck or pertrochanteric fracture |
| Difference in diagnostic accuracy of POCUS in detecting hip fractures stratified by operator experience (in years) using POCUS | From enrollment to the end of POCUS, approximately 10 to 30 minutes | Difference in diagnostic accuracy (sensitivity, specificity, negative predicting value (NPV) and positive predicting value (PPV)) of POCUS in detecting hip fractures stratified by operator experience (in years) using POCUS |
| Difference in effusion measured in mm between the ipsilateral and contralateral hip | From enrollment to the end of POCUS, approximately 10 to 30 minutes | Difference in effusion measured in mm between the ipsilateral and contralateral hip |
| Added value of POCUS in detecting hip fractures compared to the likelihood determined through clinical assessment by the treating physician | From enrollment to the end of POCUS, approximately 10 to 30 minutes | Evaluate the added value of POCUS in detecting hip fractures compared to the likelihood determined through clinical assessment by the treating physician (questionnaire: hip fracture clinical suspected yes or no) |
Countries
Netherlands
Outcome results
None listed