Page 77 - JSOM Winter 2017

using alternative tissue models (e.g., cadavers) and materials 4. Schlager D. Ultrasound detection of foreign bodies and procedure
(e.g., metal) to determine if there is an association between size guidance. Emerg Med Clin North Am. 1997;15:895–912.
and diagnostic accuracy of ultrasound for detecting foreign 5. Levine MR, Gorman SM, Young CF, et al. Clinical characteristics
bodies. Future studies could also strive to achieve sample sizes and management of wound foreign bodies in the ED. Am J Emerg
Med. 2008;26:918–922.
capable of detecting smaller differences in sensitivity values. 6. Crystal CS, Masneri DA, Hellums JS, et al. Bedside ultrasound
for the detection of soft tissue foreign bodies: a cadaveric study. J
Conclusion Emerg Med. 2009;36:377–380.
7. Leung A, Patton A, Navoy J, et al. Intraoperative sonography-
We found poor diagnostic accuracy for the use of ultrasound guided removal of radiolucent foreign bodies. J Pediatr Orthop.
to detect wooden foreign bodies in a standard tissue model. 1998;18:259–261.
We also found no significant association between foreign body 8. Chen K, Lin AC, Chong C, et al. An overview of point-of-care
ultrasound for soft tissue and musculoskeletal applications in the
size and diagnostic accuracy. Clinicians with self-reported emergency department. J Intens Care. 2016;4:55.
prior ultrasound experience performed poorly across all train- 9. Tahmasebi M, Zareizadeh H, Motamedfar A. Accuracy of ultra-
ing levels and often disagreed on the presence or absence of sonography in detecting radiolucent soft-tissue foreign bodies.
foreign body. Based on these results, we would caution emer- Indian J Radiol Imaging. 2014;24(2):196–200.
gency medicine providers against relying upon this imaging 10. Manthey DE, Storrow AB, Milbourn JM, et al. Ultrasound versus
modality to rule out the presence of potentially clinically sig- radiography in the detection of soft-tissue foreign bodies. Ann
Emerg Med. 1996;28:7–9.
nificant small wooden foreign bodies. 11. Saul T, Siadecki SD, Rose G, et al. Ultrasound for the evaluation
of soft tissue foreign bodies before and after the addition of fluid
Acknowledgments to the surrounding interstitial space in a cadaveric model. Am J
We thank John Ward for his help with the statistical analysis. Emerg Med. 2016;34(9):1779–1782.
12. Hill R, Conron R, Greissinger P, et al. Ultrasound for the detec-
tion of foreign bodies in human tissue. Ann Emerg Med. 1997;29:
Disclaimer 353–356.
The view(s) expressed herein are those of the author(s) and do 13. Nienaber A, Harvey M, Cave G. Accuracy of bedside ultrasound
not reflect the official policy or position of Brooke Army Med- for the detection of soft tissue foreign bodies by emergency doc-
ical Center, the US Army Medical Department, the US Army tors. Emerg Med Australas. 2010;22:30–34.
Office of the Surgeon General, the Department of the Army, 14. Orlinsky M, Knittel P, Feit T, et al. The comparative accuracy of
the Department of Defense, or the US Government. radiolucent foreign body detection using ultrasonography. Am J
Emerg Med. 2000;18:401–403.
15. Turkcuer I, Atilla R, Topacoglu H, et al. Do we really need plain
Disclosure and soft-tissue radiographies to detect radiolucent foreign bodies
The authors have nothing to disclose. in the ED? Am J Emerg Med. 2006;24:763–768.
16. Ginsburg MJ, Ellis GL, Flom LL. Detection of soft-tissue foreign
Author Contributions bodies by plain radiography, xerography, computed tomography,
J.H. conceived the study and worked with E.C. and E.F. on and ultrasonography. Ann Emerg Med. 1990;19:701–703.
study design. E.F. collected the data. S.S., M.A., E.C., and E.F. 17. Haghnegahdar A, Shakibafard A, Khosravifard N. Comparison
performed data analysis and interpretation. E.F. drafted the between computed tomography and ultrasonography in detecting
foreign bodies regarding their composition and depth: an in vitro
manuscript, which was then critically revised by all authors. study. J Dent Shiraz Univ Med Sci. 2016;17:177–184.
Final approval of the version of the manuscript to be pub- 18. Friedman DI, Forti RJ, Wall SP, et al. The utility of bedside ul-
lished was given by all authors. trasound and patient perception in detecting soft tissue foreign
bodies in children. Pediatr Emerg Care. 2005;21:487–492.
References 19. Rockett MS, Gentile SC, Gudas CJ, et al. The use of ultrasonog-
1. Davis J, Czerniski B, Au A, et al. Diagnostic accuracy of ultraso- raphy for the detection of retained wooden foreign bodies in the
nography in retained soft tissue foreign bodies: a systematic review foot. J Foot Ankle Surg. 1995;34:478–484; discussion 510–511.
and meta-analysis. Acad Emerg Med. 2015;22:777–787. 20. Jacobson JA, Powell A, Craig JG, et al. Wooden foreign bodies in
2. Imoisili MA, Bonwit AM, Bulas DI. Toothpick puncture injuries of soft tissue: detection at US. Radiology. 1998;206:45–48.
the foot in children. Pediatr Infect Dis J. 2004;23:80–82. 21. Turner J, Wilde CH, Hughes KC, et al. Ultrasound-guided re-
3. Yanay O, Vaughan DJ, Diab M, et al. Retained wooden foreign trieval of small foreign objects in subcutaneous tissue. Ann Emerg
body in a child’s thigh complicated by severe necrotizing fasciitis: a Med. 1997;29:731–734.
case report and discussion of imaging modalities for early diagno-
sis. Pediatr Emerg Care. 2001;17:354–355.

Emergency US to Detect Wooden Foreign Bodies | 75