Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests

Background: Undiagnosed congenital heart disease in the prenatal stage can occur in approximately 5 to 15 out of 1000 live births; more than a quarter of these will have critical congenital heart disease (CCHD). Late postnatal diagnosis is associated with a worse prognosis during childhood, and there is evidence that a standardized measurement of oxygen saturation in the newborn by cutaneous oximetry is an optimal method for the detection of CCHD. We conducted a systematic review of the literature and meta-analysis comparing the operational characteristics of oximetry and physical examination for the detection of CCHD. Methods: A systematic review of the literature was conducted on the following databases including published studies between 2002 and 2017, with no language restrictions: Pubmed, Science Direct, Ovid, Scopus and EBSCO, with the following keywords: oximetry screening, critical congenital heart disease, newborn OR oximetry screening heart defects, congenital, specificity, sensitivity, physical examination. Results: A total of 419 articles were found, from which 69 were selected based on their titles and abstracts. After quality assessment, five articles were chosen for extraction of data according to inclusion criteria; data were analyzed on a sample of 404,735 newborns in the five included studies. The following values were found, corresponding to the operational characteristics of oximetry in combination with the physical examination: sensitivity: 0.92 (CI 95%, 0.87-0.95), specificity: 0.98 (CI 95%, 0.89-1.00), for physical examination alone sensitivity: 0.53 (CI 95%, 0.28-0.78) and specificity: 0.99 (CI 95%, 0.97-1.00). Conclusions: Evidence found in different articles suggests that pulse oximetry in addition to neonatal physical examination presents optimal operative characteristics that make it an adequate screening test for detection of CCHD in newborns, above all this is essential in low and middle-income settings where technology medical support is not entirely available.

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Commentary on "Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests"

British Journal of Sports Medicine ◽

10.1136/bjsm.2007.042564 ◽

2007 ◽

Vol 42 (2) ◽

pp. 92-92

Author(s):

G. Murrell

Keyword(s):

Systematic Review ◽

Physical Examination ◽

Meta Analysis

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Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis

BMJ ◽

10.1136/bmj.l4225 ◽

2019 ◽

pp. l4225 ◽

Cited By ~ 15

Author(s):

Shannon M Fernando ◽

Alexandre Tran ◽

Wei Cheng ◽

Bram Rochwerg ◽

Monica Taljaard ◽

...

Keyword(s):

Systematic Review ◽

Intracranial Pressure ◽

Physical Examination ◽

Critically Ill ◽

Sensitivity And Specificity ◽

Critically Ill Patients ◽

Meta Analysis ◽

Elevated Intracranial Pressure ◽

Midline Shift ◽

Non Invasive

Abstract Objectives To summarise and compare the accuracy of physical examination, computed tomography (CT), sonography of the optic nerve sheath diameter (ONSD), and transcranial Doppler pulsatility index (TCD-PI) for the diagnosis of elevated intracranial pressure (ICP) in critically ill patients. Design Systematic review and meta-analysis. Data sources Six databases, including Medline, EMBASE, and PubMed, from inception to 1 September 2018. Study selection criteria English language studies investigating accuracy of physical examination, imaging, or non-invasive tests among critically ill patients. The reference standard was ICP of 20 mm Hg or more using invasive ICP monitoring, or intraoperative diagnosis of raised ICP. Data extraction Two reviewers independently extracted data and assessed study quality using the quality assessment of diagnostic accuracy studies tool. Summary estimates were generated using a hierarchical summary receiver operating characteristic (ROC) model. Results 40 studies (n=5123) were included. Of physical examination signs, pooled sensitivity and specificity for increased ICP were 28.2% (95% confidence interval 16.0% to 44.8%) and 85.9% (74.9% to 92.5%) for pupillary dilation, respectively; 54.3% (36.6% to 71.0%) and 63.6% (46.5% to 77.8%) for posturing; and 75.8% (62.4% to 85.5%) and 39.9% (26.9% to 54.5%) for Glasgow coma scale of 8 or less. Among CT findings, sensitivity and specificity were 85.9% (58.0% to 96.4%) and 61.0% (29.1% to 85.6%) for compression of basal cisterns, respectively; 80.9% (64.3% to 90.9%) and 42.7% (24.0% to 63.7%) for any midline shift; and 20.7% (13.0% to 31.3%) and 89.2% (77.5% to 95.2%) for midline shift of at least 10 mm. The pooled area under the ROC (AUROC) curve for ONSD sonography was 0.94 (0.91 to 0.96). Patient level data from studies using TCD-PI showed poor performance for detecting raised ICP (AUROC for individual studies ranging from 0.55 to 0.72). Conclusions Absence of any one physical examination feature is not sufficient to rule out elevated ICP. Substantial midline shift could suggest elevated ICP, but the absence of shift cannot rule it out. ONSD sonography might have use, but further studies are needed. Suspicion of elevated ICP could necessitate treatment and transfer, regardless of individual non-invasive tests. Registration PROSPERO CRD42018105642.

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Physical Examination Tests for Assessing a Torn Meniscus in the Knee: A Systematic Review With Meta-analysis

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2007.2560 ◽

2007 ◽

Vol 37 (9) ◽

pp. 541-550 ◽

Cited By ~ 77

Author(s):

Eric J. Hegedus ◽

Chad Cook ◽

Victor Hasselblad ◽

Adam Goode ◽

Douglas C. Mccrory

Keyword(s):

Systematic Review ◽

Physical Examination ◽

Meta Analysis

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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

Academic Emergency Medicine ◽

10.1111/acem.12984 ◽

2016 ◽

Vol 23 (9) ◽

pp. 963-1003 ◽

Cited By ~ 43

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

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

10.21203/rs.3.rs-62425/v1 ◽

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.

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