The Role of Point of Care Ultrasound (PoCUS) in Orthopaedic Emergency Diagnostics

Implementation of Point-of-Care Ultrasound (PoCUS) in Geisinger Health System

Background Point-of-care ultrasound (PoCUS) is an imaging modality with many inherent benefits, such as increased patient satisfaction, cost savings, and elimination of delays in diagnosis. The popularity of this bedside imaging technique has increased in recent years, and its scope of use for diagnostics and procedures has expanded in many specialties. Research question Can increased implementation of PoCUS within the Geisinger Health System (GHS) reduce the need for other more expensive, time-consuming, and potentially harmful imaging techniques? Methods Investigations were carried out on the uses of PoCUS established in the literature as a bedside diagnostic tool for specific pathologies such as pneumonia, nephrolithiasis, and various fractures. The SlicerDicer tool from Epic was then used to quantify diagnostic tests that could be replaced with PoCUS. Data collection focused on the number of other imaging modalities (CT, MRI, X-ray) that could be substituted with PoCUS. Data regarding the existing use of PoCUS within GHS could not be collected due to the limitations of SlicerDicer. Results Between January 1, 2019, and December 31, 2023, 121,057 imaging studies, including 38,838 CT scans, were recorded in SlicerDicer, where PoCUS could be implemented as an alternative diagnostic tool for specific pathologies. The largest portion of PoCUS-replaceable scans was chest X-ray at 61,684, followed by CT of the abdomen and pelvis at 36,204 scans in the five-year study period. Conclusions Our review of SlicerDicer data from GHS revealed substantial numbers of imaging scans that could be substituted with PoCUS. Expanding the use of PoCUS within GHS would be advantageous to both patients and providers, and we recommend that providers take advantage of opportunities to incorporate PoCUS into their clinical practice.

PoCUS identification of distal biceps tendon rupture: a case report

BACKGROUND

In the Emergency Department (ED), patients may present with various injuries that damage muscles, tendons, ligaments, and bony structures. Fractures, joint dislocations, strains, and sprains are prevalent among them. However, distal biceps tendon ruptures are uncommon.

CASE REPORT

Here, we report a case of a young man presented to the ED with a complaint of left arm pain following a martial arts activity. The diagnosis of distal biceps tendon rupture was made using a point-of-care ultrasound (PoCUS), and an early referral to the orthopedic service was provided.

CONCLUSION

This case highlights the utility of point-of-care ultrasound in assessing musculoskeletal injuries in the ED. Early incorporation of PoCUS into routine clinical practice can potentially improve the overall care of musculoskeletal injuries.