PATEL Sachi1, Fardis TAVANGARY1, Wesley TANG1, Brion BENNINGER1-9. Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences,... [ view full abstract ]
PATEL Sachi1, Fardis TAVANGARY1, Wesley TANG1, Brion BENNINGER1-9. Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences, COMP–Northwest, Lebanon, OR. USA. Departments of Orthopaedics5, General Surgery6 and Sports Medicine7, Samaritan Health Services, Corvallis, OR. USA. Departments of Surgery8, Orthopaedics & Rehabilitation9, Oregon Health & Science University, Portland, OR. USA.
INTRODUCTION. Ultrasound (US) was initially used as a diagnostic tool for orbital wall fractures in 1981. Despite this, US is not consistently being taught as a diagnostic fracture identification tool. A training method with assessment would be ideal to prepare medical students and residents to accurately identify zygomatic fractures in the emergency department. The objective of this study was to assess whether medical students could identify zygomatic fractures using various ultrasound probes on donor cadavers. METHODS. Literature search was conducted regarding US training to identify zygomatic fractures using variable probes on unembalmed cadavers (UC) for 1st year medical students (MS1). Nine unembalmed head & neck specimens were examined (ages 34-85:avg 70, 5F:4M). Twenty MS1 conducted a total of 340 independent trials; 10 performed 170 trials using novel Sonivate Finger Probe (SFP), 10 using a classic linear probe (CLP, 5-12 MHz). True-positives (TP), true-negatives (TN), false-positives (FP) and false-negatives (FN) were recorded for the zygomatic region. Students (13M, 7F) who were chosen had previous US experience with limbs and cavities, but not with bony structures of the head and neck region. RESULTS. Literature search revealed no known studies using US to identify zygomatic skull fractures on UC. 20 students correctly identified the presence or absence of a fracture 87.9% of the time. More TP and TN were identified with the SFP versus the CLP (p-value = 0.09). DISCUSSION. US is safe and can be conducted in real-time to diagnose zygomatic fractures, with high sensitivity and specificity (94% and 89%, respectively, using the novel SFP). Plain radiographs and computed tomography (CT) imaging are the gold-standard for zygomatic fractures. Both require departmental imaging and deliver radiation exposure, and, with CT, a high associated cost. US, however, is safe, cost efficient, and can be conducted in real-time. In order to have a cultural educational shift, training methods should be integrated into medical school curriculum. CONCLUSION. This study suggests UC can be successfully examined as an US training method to identify and exclude zygomatic fractures using novel finger and classic linear probes with high sensitivity and specificity.
Use of ultrasound in Undergraduate Medical Education , Technology , New Uses
