open access

Vol 8, No 3 (2023)
Research paper
Published online: 2023-04-21
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Comparison of conventional radiography and computed tomography in patients admitted to the emergency department with extremity trauma — a retrospective study

Burak Üstün1, Mustafa Korkut2, Seçgin Söyüncü3
·
Disaster Emerg Med J 2023;8(3):141-150.
Affiliations
  1. Department of Emergency Medicine, Ardahan State Hospital, Turkiye
  2. Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Turkiye
  3. Department of Emergency Medicine, Akdeniz University School of Medicine Antalya, Turkiye

open access

Vol 8, No 3 (2023)
ORIGINAL ARTICLES
Published online: 2023-04-21

Abstract

INTRODUCTION: This study aims to compare conventional radiography (X-ray) and computed tomography (CT) on diagnosis, operation plan, and hospitalization of patients with isolated extremity trauma admitted to the emergency department (ED).

MATERIAL AND METHODS: This study was designed retrospectively. Patients with trauma involving extremities presenting to a tertiary ED between January 2019 and 2020 for twelve months who underwent both extremity CT and X-ray imaging were included in the study. The sensitivity, specificity, PPV, NPV, and Kappa coefficients were calculated on the CT reports.

RESULTS: A total of 1306 patients were included in the study. Extremity fractures were detected in 620 (47.6%) and 775 (59.3%) patients evaluated with X-ray, and CT scans respectively. The diagnostic accuracy of the X-ray of all extremity fractures by anatomical region was evaluated. For the shoulder region compared with CT, X-ray had a sensitivity of 95%, specificity of 98%, PPV 98%, and NPV 96% [AUC: 0.969, 95% CI 0.935 to 1.000) in diagnosing proximal humeral fractures. For the elbow joint region compared with CT, X-ray had a sensitivity of 95%, specificity of 98%, PPV 88%, and NPV 99% in diagnosing supracondylar fracture (AUC: 0.973, 95% CI 0.924–1.000). X-ray had a sensitivity of 94%, and specificity of 100%, compared with CT at the wrist region, PPV of 100%, and NPV of 98% in diagnosing distal ulnar fractures (AUC: 0.974, 95% CI 0.941 to 1.000). The most common knee fracture was a proximal tibia fracture on X-ray. Compared with CT, X-ray had a sensitivity for the diagnosis of proximal fibular fractures with 85% sensitivity, 100% specificity, PPV 100%, and NPV 98% (AUC: 0.925, 95% CI 0.832 to 1.000). At the ankle region, distal tibia fracture was the most common fracture on X-ray. Compared with CT, X-ray had a sensitivity of 85%, specificity of 98%, PPV 96%, and NPV 94% (AUC: 0.922, 95% CI 0.879 to 0.966) in the diagnosis of distal fibular fractures. The sensitivity of the X-ray was very low compared to CT in the talus, calcaneus, navicular, and cuneiform bones.

CONCLUSIONS: For upper extremities, X-ray can be useful to determine diagnosing proximal humerus, supracondylar, distal radius, and ulna fracture. Additionally for lower extremities, it can be used in the diagnosis of proximal fibular fractures and distal tibia-fibular fractures. X-ray is beneficial for long bones and CT for carpal and tarsal bones.

Abstract

INTRODUCTION: This study aims to compare conventional radiography (X-ray) and computed tomography (CT) on diagnosis, operation plan, and hospitalization of patients with isolated extremity trauma admitted to the emergency department (ED).

MATERIAL AND METHODS: This study was designed retrospectively. Patients with trauma involving extremities presenting to a tertiary ED between January 2019 and 2020 for twelve months who underwent both extremity CT and X-ray imaging were included in the study. The sensitivity, specificity, PPV, NPV, and Kappa coefficients were calculated on the CT reports.

RESULTS: A total of 1306 patients were included in the study. Extremity fractures were detected in 620 (47.6%) and 775 (59.3%) patients evaluated with X-ray, and CT scans respectively. The diagnostic accuracy of the X-ray of all extremity fractures by anatomical region was evaluated. For the shoulder region compared with CT, X-ray had a sensitivity of 95%, specificity of 98%, PPV 98%, and NPV 96% [AUC: 0.969, 95% CI 0.935 to 1.000) in diagnosing proximal humeral fractures. For the elbow joint region compared with CT, X-ray had a sensitivity of 95%, specificity of 98%, PPV 88%, and NPV 99% in diagnosing supracondylar fracture (AUC: 0.973, 95% CI 0.924–1.000). X-ray had a sensitivity of 94%, and specificity of 100%, compared with CT at the wrist region, PPV of 100%, and NPV of 98% in diagnosing distal ulnar fractures (AUC: 0.974, 95% CI 0.941 to 1.000). The most common knee fracture was a proximal tibia fracture on X-ray. Compared with CT, X-ray had a sensitivity for the diagnosis of proximal fibular fractures with 85% sensitivity, 100% specificity, PPV 100%, and NPV 98% (AUC: 0.925, 95% CI 0.832 to 1.000). At the ankle region, distal tibia fracture was the most common fracture on X-ray. Compared with CT, X-ray had a sensitivity of 85%, specificity of 98%, PPV 96%, and NPV 94% (AUC: 0.922, 95% CI 0.879 to 0.966) in the diagnosis of distal fibular fractures. The sensitivity of the X-ray was very low compared to CT in the talus, calcaneus, navicular, and cuneiform bones.

CONCLUSIONS: For upper extremities, X-ray can be useful to determine diagnosing proximal humerus, supracondylar, distal radius, and ulna fracture. Additionally for lower extremities, it can be used in the diagnosis of proximal fibular fractures and distal tibia-fibular fractures. X-ray is beneficial for long bones and CT for carpal and tarsal bones.

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Keywords

extremity trauma; fracture; computed tomography; x-ray; emergency department

About this article
Title

Comparison of conventional radiography and computed tomography in patients admitted to the emergency department with extremity trauma — a retrospective study

Journal

Disaster and Emergency Medicine Journal

Issue

Vol 8, No 3 (2023)

Article type

Research paper

Pages

141-150

Published online

2023-04-21

Page views

474

Article views/downloads

432

DOI

10.5603/DEMJ.a2023.0016

Bibliographic record

Disaster Emerg Med J 2023;8(3):141-150.

Keywords

extremity trauma
fracture
computed tomography
x-ray
emergency department

Authors

Burak Üstün
Mustafa Korkut
Seçgin Söyüncü

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