Assuntos
Cisto Folicular/diagnóstico , Militares , Neoplasia de Células Basais/diagnóstico , Neoplasias Cutâneas/diagnóstico , Guerra , Cisto Folicular/diagnóstico por imagem , França/etnologia , Humanos , Masculino , Mali , Neoplasia de Células Basais/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Adulto JovemRESUMO
INTRODUCTION: To evaluate the usefulness of point-of-care ultrasound (POCUS) performed by young military medicine residents after short training in the diagnosis of medical emergencies. METHODS: A prospective study was performed in the emergency department of a French army teaching hospital. Two young military medicine residents received ultrasound training focused on gall bladder, kidneys and lower limb veins. After clinical examination, they assigned a 'clinical diagnostic probability' (CP) on a visual analogue scale from 0 (definitely not diagnosis) to 10 (definitive diagnosis). The same student performed ultrasound examination and assigned an 'ultrasound diagnostic probability' (UP) in the same way. The absolute difference between CP and UP was calculated. This result corresponded to the Ultrasound Diagnostic Index (UDI), which was positive if UP was closer to the final diagnosis than CP (POCUS improved the diagnostic accuracy), and negative conversely (POCUS decreased the diagnostic accuracy). RESULTS: Forty-eight patients were included and 48 ultrasound examinations were performed. The present pathologies were found in 14 patients (29%). The mean UDI value was +3 (0-5). UDI was positive in 35 exams (73%), zero in 12 exams (25%) and negative in only one exam (2%). CONCLUSION: POCUS performed after clinical examination increases the diagnostic accuracy of young military medicine residents.
Assuntos
Serviços Médicos de Emergência/normas , Militares/educação , Ultrassonografia/instrumentação , Ultrassonografia/normas , Adulto , Idoso , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/tendências , Feminino , França , Humanos , Internato e Residência/métodos , Internato e Residência/tendências , Masculino , Pessoa de Meia-Idade , Medicina Militar/instrumentação , Medicina Militar/métodos , Medicina Militar/normas , Militares/estatística & dados numéricos , Exame Físico/instrumentação , Exame Físico/métodos , Sistemas Automatizados de Assistência Junto ao Leito/normas , Sistemas Automatizados de Assistência Junto ao Leito/tendências , Estudos Prospectivos , Ultrassonografia/tendênciasRESUMO
INTRODUCTION: Isolated posterior tibial malleolar fracture, which concerns parachutists in particular, is rare and often overlooked. The present study sought to identify clinical and paraclinical factors able to improve diagnosis and treatment. HYPOTHESIS: Marginal posterior malleolar fracture is under-diagnosed due to lack of awareness and difficulty of diagnosis. Delayed diagnosis may impair functional prognosis. MATERIAL AND METHOD: A multicenter retrospective study included 12 cases of isolated marginal posterior malleolar fracture in military parachutists between 2006 and 2011. Clinical and paraclinical data were collected from medical files and a questionnaire administered in consultation or by telephone. RESULTS: Diagnosis was initially overlooked in 75% of cases due to non-specific clinical presentation and the low sensitivity of plain radiographs. Diagnostic delay impaired functional outcome. DISCUSSION: Symptomatology, other than medial retromalleolar pain, is misleading. The Ottawa Ankle Rules should not be used in this particular form of trauma. X-ray should include a lateral view in 50° external rotation. CT provides a useful complement. Delayed diagnosis puts the patient at risk of impaired functional prognosis. LEVEL OF EVIDENCE: IV (retrospective study).
