Dear Readers: Ultrasound is vibration transmitted at a frequency > 20 KHz, the approximate upper limit of human hearing. Ultrasound has been used for diagnosis and treatment of various conditions, including skin and wound evaluations.^1,2 The first article reviewed in this month’s Evidence Corner addresses the question of whether gross ultrasound adds value as an adjunct in diagnosis and management planning for patients with traumatic wounds. Attempts to use ultrasound as a wound treatment modality have been reviewed elsewhere,^3,4 and authors have concluded that evidence to support efficacy was insufficient.⁴ Studies using ultrasound as an adjunctive therapy for healing diabetic foot ulcers⁵ and venous ulcers⁶ attempted to define administration and dosage parameters, but questions remain regarding clinical healing efficacy. The second article is a systematic literature review that studied ultrasound effects on pressure ulcer healing, underscoring the need for further research of this effect.

Ultrasonography Aids Diagnosis of Trauma Patients

       Reference: Melniker LA, Leibner F, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48(3):227–235.
       Rationale: More than 38 million people in the United States are evaluated annually for trauma, which is the leading cause of death in people younger than 45 years.
       Objective: This study assessed the value of adding point-of-care, limited ultrasonography (PLUS) to the protocol for managing patients with suspected torso trauma reporting to the emergency department.
       Methods: A prospective, randomized, controlled study evaluated 444 patients reporting to 2 level 1 trauma centers with torso trauma during a 6-month period. Patients were randomly assigned to receive standard trauma care with or without PLUS administered by experienced clinical sonographers. The primary outcome measured was time from emergency department (ED) arrival to transfer to operative care. Secondary measures were computed tomography (CT) use, length of hospital stay (LOS), complications, and charges. Quartile values and odds ratios with 95% confidence intervals were derived from intent-to-treat regression analysis controlled for physician and patient confounding variables.
       Results: One hundred thirty five PLUS patients and 127 control patients qualified for analysis. There were no significant differences between the groups on enrollment. Patients in the PLUS group experienced 64% shorter time to operative care and spent 27% fewer days in the hospital. Patients in the PLUS group had fewer complications and fewer CT scans than the control group (P < 0.05 for all effects).
       Conclusion: A protocol of care including PLUS decreased time to operative care while reducing complications and charges for patients with suspected torso trauma.

Does Ultrasound Add Therapeutic Value for Pressure Ulcers?

       Reference: Baba-Akbari Sari A, Flemming K, Cullum NA, Wollina U. Therapeutic ultrasound for pressure ulcers. Cochrane Database Syst Rev. 2006; 3:CD001275.
       Rationale: Pressure ulcers occur in 5%–32% of hospitalized patients and 4%–7% of home care patients in the United Kingdom. Treatment modalities that facilitate healing would reduce the burden of their care.
       Objective: The authors’ objective was to determine the therapeutic effects of ultrasound on pressure ulcer healing.
       Methods: A retrospective search of the Cochrane database, abstracts, conference proceedings, and references identified controlled studies exploring the effects of ultrasound modalities on measured healing of pressure ulcers. Data extraction was performed by one author and verified by another author of this review. Meta-analysis determined the statistical significance of ultrasound effects on pressure ulcer healing.
       Results: Three controlled studies involving 146 patients with pressure ulcers were identified. Two randomized, controlled trials found no significant difference between healing rates of pressure ulcers managed with ultrasound as compared to sham treatment. A meta-analysis combining their homogeneous data also found no significant effect of ultrasound on healing. The third study compared ultrasound combined with ultraviolet light to laser therapy or standard care and found no significant effect of ultrasound on pressure ulcer healing.
       Conclusions: The authors found that the evidence was insufficient to conclude that ultrasound provides any healing benefit to patients with pressure ulcers. The authors also noted that the small sample sizes and study limitations prevented a conclusion that ultrasound was either beneficial or harmful to pressure ulcers. The authors recommended that further research be conducted before drawing a firm conclusion.