Ultrasound vs Landmark Guided Medium Sized Joint Arthrocentesis: A Randomized Clinical Trial

Link to article at PubMed

Acad Emerg Med. 2021 Oct 4. doi: 10.1111/acem.14396. Online ahead of print.


OBJECTIVES: Arthrocentesis is commonly performed in the emergency department, but success rates vary based on location. Presently, there is a paucity of data assessing the utility of ultrasound guided medium sized joint arthrocentesis. The objective of this study is to compare the success of ultrasound guided (USG) and landmark guided (LMG) medium sized joint arthrocentesis.

METHODS: This was a single center, prospective, randomized clinical trial (NCT03327584) of a convenience sample of adult patients who presented to an urban, university hospital with >105,000 visits annually. Patients with a suspected medium sized joint effusion (defined as elbow, wrist, or ankle) undergoing arthrocentesis were randomized into LMG or USG using the GE Logiq e linear transducer (4-10 MHz). The following patients were excluded: on anticoagulation, with soft tissue infection overlying the joint, or involving an artificial joint. Statistical analysis included the Fisher Exact, Mann-Whitney U and t-test.

RESULTS: Overall, 44 patients were enrolled with 23 patients randomized into the LMG group and 21 patients into the USG arm. USG was significantly better than LMG with an overall success of 94.1% vs 60% for LMG (difference of 34.1%, 95% CI 4.90 - 58.83). USG first pass success was 82.4% vs 46.7% for LMG (difference of 35.7%; 95% CI 2.76 - 60.37) and a mean of 1.35 attempts vs 2.00 for LMG (difference of 0.65; 95% CI 0.005 - 1.296). Of the 14 LMG failures, 8 had no effusion present on USG crossover. 4 patients in the USG group had no effusion present.

CONCLUSIONS: Ultrasound guidance improved first pass and overall successful arthrocentesis of medium sized joint effusions.

PMID:34608713 | DOI:10.1111/acem.14396

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