Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: We compared the immediate cosmetic outcome of metallic foreign-body removal by emergency medicine (EM) residents with ultrasound guidance and conventional radiography.

Methods: This single-blinded, randomized, crossover study evaluated the ability of EM residents to remove metallic pins embedded in pigs’ feet. Before the experiment, we embedded 1.5-cm metallic pins into numbered pigs’ feet. We randomly assigned 14 EM residents to use either ultrasound or radiography to help remove the foreign body. Residents had minimal ultrasound experience. After a brief lecture, we provided residents with a scalpel, laceration kit, a bedside portable ultrasound machine, nipple markers, paper clips, a dedicated radiograph technician, and radiograph machine 20 feet away. After removal, 3 board-certified emergency physicians, who were blinded to the study group, evaluated the soft-tissue model by using a standardized form. They recorded incision length and cosmetic appearance on the Visual Analogue Scale.

Results: In total, 28 foreign bodies were removed. No significant difference in the time of removal (P¼ 0.12), cosmetic appearance (P ¼ 0.96), or incision length (P ¼ 0.76) was found.

Conclusion: This study showed no difference between bedside ultrasound and radiography in assisting EM residents with metallic foreign-body removal from soft tissue. No significant difference was found in removal time or cosmetic outcome when comparing ultrasound with radiography.