Diagnostic accuracy of scapular physical examination tests for shoulder disorders: a systematic review

2012 ◽  
Vol 47 (14) ◽  
pp. 886-892 ◽  
Author(s):  
Alexis A Wright ◽  
Craig A Wassinger ◽  
Mason Frank ◽  
Lori A Michener ◽  
Eric J Hegedus
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Shoulder Disorders

scholarly journals Special Physical Examination Tests for Superior Labrum Anterior-Posterior Shoulder Tears: An Examination of Clinical Usefulness

2013 ◽  
Vol 48 (6) ◽  
pp. 856-858 ◽  
Author(s):  
Michelle A. Sandrey
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Confidence Intervals ◽  
Biceps Tendon ◽  
Tendon Injury ◽  
Slap Lesion ◽  
Superior Labrum ◽  
Posterior Shoulder ◽  
Anterior Posterior

Reference/Citation: Calvert E, Chambers GK, Regan W, Hawkins RH, Leith JM. Special physical examination tests for superior labrum anterior-posterior shoulder injuries are clinically limited and invalid: a diagnostic systematic review. J Clin Epidemiol. 2009;62(5):558–563. Clinical Question: The systematic review focused on diagnostic accuracy studies to determine if evidence was sufficient to support the use of superior labrum anterior-posterior (SLAP) physical examination tests as valid and reliable. The primary question was whether there was sufficient evidence in the published literature to support the use of SLAP physical examination tests as valid and reliable diagnostic test procedures. Data Sources: Studies published in English were identified through database searches on MEDLINE, EMBASE, and the Cochrane database (1970–2004) using the search term SLAP lesions. The medical subject headings of arthroscopy, shoulder joint, and athletic injuries were combined with test or testing, physical examination, and sensitivity and specificity to locate additional sources. Other sources were identified by rereviewing the reference lists of included studies and review articles. Study Selection: Studies were eligible based on the following criteria: (1) published in English, (2) focused on the physical examination of SLAP lesions, and (3) presented original data. A study was excluded if the article was limited to a clinical description of 1 or more special tests without any research focus to provide clinical accuracy data or if it did not focus on the topic. Data Extraction: The abstracts that were located through the search strategies were reviewed, and potentially relevant abstracts were selected. Strict epidemiologic methods were used to obtain and collate all relevant studies; the authors developed a study questionnaire to record study name, year of publication, study design, sample size, and statistics. Validity of the diagnostic test study was determined by applying the 5 criteria proposed by Calvert et al. If the study met the inclusion and validity criteria, 95% confidence intervals were calculated for each sensitivity, specificity, and positive and negative likelihood ratio reported. No specific information was provided about the procedure if the reviewers disagreed on how the evaluation criteria were applied. Main Results: The specific search criteria led to the identification of 29 full-text articles. The studies were reviewed, and inclusion and exclusion criteria were applied. This resulted in 14 excluded studies and 15 eligible studies for analysis. Of the 15 eligible studies, 1 evaluated only a single physical examination test for a SLAP lesion or biceps tendon injury, and 10 studies evaluated 2 to 6 physical examination tests for a SLAP lesion or biceps tendon injury. Nine studies reported sensitivities and specificities greater than 75%, 4 had sensitivities less than 75%, 3 had specificities less than 75%, 1 did not report sensitivity, and 2 did not report specificities. When validity was assessed for those 15 papers, only 1 study that evaluated the biceps tendon met the 5 critical appraisal criteria of Calvert et al and calculated 95% confidence intervals. When the Speed and Yergason tests were each compared with the gold standard (arthroscopy), the confidence intervals for the positive and negative likelihood ratios spanned 1. This indicated that the test result is unlikely to change the odds of having or not having the condition, respectively. Conclusions: The literature currently used as a reference for teaching in medical schools and continuing education lacks the necessary validity to help rule in or out a SLAP lesion or biceps tendon involvement. Based on the results from the systematic review conducted by Calvert et al, no tests clinically diagnose a SLAP lesion. This is a cause for concern as magnetic resonance imaging or magnetic resonance arthrography, which are frequently used to assess a possible SLAP lesion, may also have diagnostic flaws and may be cost prohibitive. Performing arthroscopy on every patient to rule the condition in or out is unethical, especially if a SLAP lesion is not present. More rigorous validity studies should be conducted for SLAP lesion physical examination tests using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool or Standards for Reporting Diagnostic Accuracy (STARD) criteria.

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.

Diagnostic accuracy of physical examination for anterior knee instability: a systematic review

2015 ◽  
Vol 23 (10) ◽  
pp. 2805-2813 ◽  
Author(s):  
Marie-Claude Leblanc ◽  
Marcin Kowalczuk ◽  
Nicole Andruszkiewicz ◽  
Nicole Simunovic ◽  
Forough Farrokhyar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Knee Instability ◽  
Anterior Knee

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 The Accuracy of Physical Examination to Diagnose Anemia Among Patients 5 Years of Age or Older: A Systematic Review of the Literature

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 23-24
Author(s):  
Neha Vyas ◽  
Oluwatoyosi Onwuemene ◽  
Stephanie Hendren ◽  
Charu Monga ◽  
Tushar Sehgal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Global Health ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Text Analysis ◽  
Full Text ◽  
Physical Exam ◽  
Nutritional Deficiencies ◽  
Non Invasive ◽  
Wide Range

BACKGROUND: Anemia remains a significant public health challenge, with a disproportionate impact on lower-income patients residing in areas of lesser healthcare resources. These patients frequently share limited access to routine laboratory testing, and as a result, physical examination still serves as a critical tool for anemia assessments. Significant efforts have been directed toward quantifying the accuracy of physical exam to diagnose anemia among pediatric patients, who may face developmental delays stemming from nutritional deficiencies. Nonetheless, the widespread prevalence of anemia contributes to substantial cardiovascular burden for a large volume of older patients. We sought to evaluate the accuracy of clinical exam techniques to diagnose anemia among patients 5 years of age or older. METHODS: A systematic review of five databases (MEDLINE via OVID, EMBASE, Scopus, Global Health and Global Health Archives, and WHO Global Index Medicus) was conducted to evaluate studies published before February 2020. Studies that 1) compared non-invasive physical exam techniques with anemia diagnoses using standard laboratory measurements and 2) solely assessed or separately reported the diagnostic accuracy of physical exam techniques for patients 5 years or older were considered for inclusion. Studies that 1) investigated patients with specific hematologic conditions, namely sickle cell anemia, thalassemia, and acute leukemia, and/or 2) evaluated the utility of novel non-invasive devices to measure hemoglobin concentration were excluded. Two authors initially screened titles and abstracts from the search results using the Covidence web-based software platform. The full-text publications of selected abstracts were reviewed thereafter. The diagnostic accuracies of individual and collective physical exam techniques to diagnose anemia were documented. This systematic review was registered with PROSPERO. RESULTS: The systemic literature search yielded 6,457 unique studies after removal of duplicates. Following screening of titles and abstracts, 97 studies were selected for full-text analysis. Fourteen studies were ultimately selected for inclusion. Evaluation of subjects under the age of 5 years and lack of comparison between physical exam findings and anemia diagnoses were the two most common reasons for exclusion at time of full-text analysis. Of the 14 selected publications, 8 studies solely assessed pregnant females, 3 solely assessed hospitalized patients, and 3 evaluated the general population. Five studies were conducted in South Asia, and 4 were conducted in Africa. The most frequently evaluated physical exam technique was assessment of clinical pallor, and the anatomical sites most often examined were conjunctivae, nail bed, and palms. The diagnostic accuracy ranged widely for pallor assessments of conjunctivae (sensitivity: 19% - 97%, specificity: 65% - 100%), nailbed (sensitivity: 41% - 65%, specificity: 58% - 93%), and palms (sensitivity: 33% - 91%, specificity: 54% - 93%). Similarly, sensitivity and specificity of collectivizing at least two or more physical exam findings to diagnose anemia ranged from 26% to 96% and 13% to 99%, respectively. CONCLUSIONS: Though frequently implemented in practice, the accuracy of assessing clinical pallor to diagnose anemia is unclear. The wide range in previously reported associations between exam findings and anemia diagnoses is likely due to heterogenous populations being investigated. More robust studies are required to identify the most optimal exam technique or combination of techniques to screen and/or diagnose anemia among patients without concurrent pregnancy or significant co-morbidities. Disclosures No relevant conflicts of interest to declare.

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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