Developing a Training Tool for Novice Ultrasound Users Identifying Skull and Facial Fractures with Unembalmed Cadaveric Tissue Using Multiple Probes

SANDERS David1, Elizabeth RICHARDSON1, Wesley TANG1, Ian BLANDFORD1, Brion BENNINGER1-9. Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of... [ view full abstract ]

SANDERS David1, Elizabeth RICHARDSON1, Wesley TANG1, Ian BLANDFORD1, 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. Skull and facial fractures commonly present to Emergency Departments (ED). Current CT results in increased cost, exposure, and scanner backlog. Previous studies revealed diagnostic utility of ultrasound (US) in identifying skull & facial fractures (SFF). The objective of this study was to develop a training tool that could be used in an anatomy lab to identify skull and facial fractures on unembalmed cadaveric tissue. METHODS. Literature search was conducted investigating US identification of SFF. Nine unembalmed (UC) head & neck specimens were examined. Twenty 1st-year medical students conducted a total of 840 independent trials; 420 (80 nasal, 170 zygomatic, 170 temporal) using novel Sonivate Finger Probe (SFP), 420 using classic linear probe (CLP), 5-12 MHz. True-positives, true-negatives, false-positives and false-negatives were recorded. Students were chosen with previous US experience with limbs and cavities but not with bony head & neck structures. Identification of fractures was compared between SFP and CLP. Likert scale questionnaire was conducted regarding value of the training session. RESULTS. Literature search revealed no known studies of US identification of SFF by novice users. Sensitivity and specificity of trials on fractures of: nasal–64%, 83%; temporal-90%, 95%; zygomatic-94%, 89%. Likert score was 4.85/5 regarding value of the training tool. DISCUSSION. All 20 students in this study successfully provided a diagnosis within 1 minute. While there was no statistically significant difference between fracture detection using SFP and CLP, the difference may be clinically significant in detection of zygomatic fractures (p-value=0.09). In order to facilitate a shift in US education, a training tool needs to be integrated at the medical school or resident level. An ideal time to expose medical students to this training tool is following head & neck dissection and previous exposure of US of the torso cavities during anatomy lab. CONCLUSION. This study demonstrated an US training tool could be successfully implemented using UC and either SFP or CLP probes. This could be a triage tool, expedite diagnosis and improve treatment.