scholarly journals Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds

2016 ◽  
Vol 23 (9) ◽  
pp. 963-1003 ◽  
Author(s):  
Christopher R. Carpenter ◽  
Adnan M. Hussain ◽  
Michael J. Ward ◽  
Gregory J. Zipfel ◽  
Susan Fowler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Lumbar Puncture ◽  
Meta Analysis ◽  
Test Thresholds ◽  
Spontaneous Subarachnoid Hemorrhage

scholarly journals Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Yohei Okada ◽  
Norihiro Nishioka ◽  
Shigeru Ohtsuru ◽  
Yasushi Tsujimoto
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Clinical Utility ◽  
Meta Analysis ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Threshold Probability

Abstract Background: Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients.Methods: Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8,300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis.Results: The median prevalence of pelvic fracture was 10.5% (interquartile range: 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10%–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion: Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

Clinical presentations and outcomes of Takotsubo syndrome in the setting of subarachnoid hemorrhage: A systematic review and meta-analysis

2016 ◽  
Vol 7 (3) ◽  
pp. 236-245 ◽  
Author(s):  
Akram Y Elgendy ◽  
Islam Y Elgendy ◽  
Hend Mansoor ◽  
Ahmed N Mahmoud
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Random Effects ◽  
Odds Ratio ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Takotsubo Syndrome ◽  
Spontaneous Subarachnoid Hemorrhage

Background: Evidence remains inconsistent regarding the incidence and prognosis of Takotsubo syndrome in the setting of subarachnoid hemorrhage. Thus, we aimed to evaluate the clinical presentation and in-hospital mortality of these patients. Methods: A systematic review of the electronic databases was conducted for studies involving patients with spontaneous subarachnoid hemorrhage and concomitant findings of classical Takotsubo syndrome on transthoracic echocardiogram. A meta-analysis was conducted for the primary outcome of in-hospital mortality using the Mantel–Haenszel method for fixed effects and the DerSimonian and Laird method for random effects, with 95% confidence interval and a p-value <0.05 for statistical significance. Results: Ten studies were retrieved with a total of 157 patients presenting with classical Takotsubo syndrome, representing 4.4% of the subarachnoid hemorrhage total population. The overall incidence of in-hospital mortality was 30% in the patients who developed Takotsubo syndrome. Meta-analysis illustrated a significant increase in the odds of in-hospital mortality for the Takotsubo syndrome patients by fixed effects model (odds ratio 2.6, 95% confidence interval 1.16–5.85, p=0.02, I2=39%), with a trend towards increased risk of in-hospital mortality by random effects model (odds ratio 3.00, 95% confidence interval 0.90–9.77, p = 0.07). Conclusions: The incidence of Takotsubo syndrome in patients with spontaneous subarachnoid hemorrhage seems to be high with a trend towards higher risk of in-hospital mortality in those patients. Thus, patients presenting with subarachnoid hemorrhage might benefit from a comprehensive cardiac evaluation upon presentation for early detection and proper triage of this high-risk population.

scholarly journals Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yohei Okada ◽  
Norihiro Nishioka ◽  
Shigeru Ohtsuru ◽  
Yasushi Tsujimoto
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Clinical Utility ◽  
Meta Analysis ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Threshold Probability

Abstract Background Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients. Methods Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis. Results The median prevalence of pelvic fracture was 10.5% (interquartile range, 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

scholarly journals Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Yohei Okada ◽  
Norihiro Nishioka ◽  
Shigeru Ohtsuru ◽  
Yasushi Tsujimoto
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Clinical Utility ◽  
Meta Analysis ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Threshold Probability

Abstract Background: Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients. Methods: Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8,300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis. Results: The median prevalence of pelvic fracture was 10.5% (interquartile range: 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10%–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion: Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

scholarly journals Diagnostic accuracy of physical examination to detect the pelvic fractures among the blunt trauma patients; systematic review and meta-analysis

2020 ◽  
Author(s):  
Yohei Okada ◽  
Norihiro Nishioka ◽  
Yasushi Tsujimoto
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Meta Analysis ◽  
Pelvic Fractures ◽  
Controlled Trials ◽  
Trauma Patients ◽  
Target Condition

AbstractBackgroundThe study aims to perform systematic review and meta-analysis to identify the diagnostic accuracy of physical examination for pelvic fracture among the blunt trauma patients.MethodWe will perform a systematic review and meta-analysis for diagnostic test accuracy (DTA). We will include all reports on the diagnostic accuracy of physical examinations for detecting pelvic fractures. We will include the studies designed as prospective or retrospective observational (cohort or cross-sectional) studies or secondary analysis of randomized controlled trials. The target participants are blunt trauma patients with potential pelvic injury. The target condition is pelvic fracture. The index test being investigated is physical examination for pelvic fracture. The reference standard is X-ray or computed tomography to confirm the target condition. We will search MEDLINE, EMBASE and The Cochrane Library inclusive of Cochrane Controlled Trials Register. Two authors will independently screen the study eligibility and extract data. Screening will be a two-step process with initial title/abstract screening followed by full-text screening. We will evaluate the risk of bias independently by two investigators and reported according to the QUADAS-2 tool. In the meta-analysis, we will use a bivariate random-effects model to report the summary receiver operating characteristic (SROC) point (summary values for sensitivity and specificity) and the 95% confidence region around the summary ROC point.Trial registrationThis review is submitted with University hospital medical information network clinical trial registry (UMIN-CTR) [UMIN000038785].

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