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 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].

Diagnostic Accuracy of Imaging Modalities and Injection Techniques for the Diagnosis of Femoroacetabular Impingement/Labral Tear: A Systematic Review With Meta-analysis

2017 ◽  
Vol 45 (11) ◽  
pp. 2665-2677 ◽  
Author(s):  
Michael P. Reiman ◽  
Kristian Thorborg ◽  
Adam P. Goode ◽  
Chad E. Cook ◽  
Adam Weir ◽  
...  
Keyword(s):  
Systematic Review ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Clinical Utility ◽  
Meta Analysis ◽  
Pretest Probability ◽  
Labral Tear ◽  
Moderate Degree ◽  
Imaging Findings ◽  
Injection Techniques

Background: Diagnosing femoroacetabular impingement/acetabular labral tear (FAI/ALT) and subsequently making a decision regarding surgery are based primarily on diagnostic imaging and intra-articular hip joint injection techniques of unknown accuracy. Purpose: Summarize and evaluate the diagnostic accuracy and clinical utility of various imaging modalities and injection techniques relevant to hip FAI/ALT. Study Design: Systematic review with meta-analysis. Methods: A computer-assisted literature search was conducted of MEDLINE, CINAHL, and EMBASE databases using keywords related to diagnostic accuracy of hip joint pathologic changes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies (QUADAS) tool. Random effects models were used to summarize sensitivities (SN), specificities (SP), likelihood ratios (+LR and –LR), diagnostic odds ratios (DOR), and respective confidence intervals (CI). Results: The search strategy and assessment for risk of bias revealed 25 articles scoring above 10/14 on the items of the QUADAS. Four studies investigated FAI, and the data were not pooled. Twenty articles on ALT qualified for meta-analysis. Pretest probability of ALT in the studies in this review was 81% (72%-88%), while the pretest probability of FAI diagnosis was 74% (95% CI, 51%-91%). The meta-analysis showed that computed tomography arthrography (CTA) demonstrated the strongest overall diagnostic accuracy: pooled SN 0.91 (95% CI, 0.83-0.96); SP 0.89 (95% CI, 0.74-0.97); +LR 6.28 (95% CI, 2.78-14.21); –LR 0.11 (95% CI, 0.06-0.21); and DOR 64.38 (95% CI, 19.17-216.21). Conclusion: High pretest probability of disease was demonstrated. Positive imaging findings increased the probability that a labral tear existed by a minimal to small degree with the use of magnetic resonance imaging/magnetic resonance angiogram (MRI/MRA) and ultrasound (US) and by a moderate degree for CTA. Negative imaging findings decreased the probability that a labral tear existed by a minimal degree with the use of MRI and US, a small to moderate degree with MRA, and a moderate degree with CTA. Clinical Relevance: Although findings of the included studies suggested potentially favorable use of these modalities for the diagnosis of ALT and FAI, our results suggest that these findings have limited generalizability and clinical utility given very high pretest prevalence, large confidence intervals, and selection criteria of the studies. Registration: PROSPERO Registration #CRD42015027745.

scholarly journals Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 727-738 ◽  
Author(s):  
Stuart Netherton ◽  
Velimir Milenkovic ◽  
Mark Taylor ◽  
Philip J. Davis
Keyword(s):  
Systematic Review ◽  
Pericardial Effusion ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Group Analysis ◽  
Initial Assessment ◽  
Free Fluid ◽  
Trauma Patients ◽  
Full Text Review ◽  
Rule Out

ABSTRACTObjectivesPerforming an extended Focused Assessment with Sonography in Trauma (eFAST) exam is common practice in the initial assessment of trauma patients. The objective of this study was to systematically review the published literature on diagnostic accuracy of all components of the eFAST exam.MethodsWe searched Medline and Embase from inception through October 2018, for diagnostic studies examining the sensitivity and specificity of the eFAST exam. After removal of duplicates, 767 records remained for screening, of which 119 underwent full text review. Meta-DiSc™ software was used to create pooled sensitivities and specificities for included studies. Study quality was assessed using the Quality in Prognostic Studies (QUADAS-2) tool.ResultsSeventy-five studies representing 24,350 patients satisfied our selection criteria. Studies were published between 1989 and 2017. Pooled sensitivities and specificities were calculated for the detection of pneumothorax (69% and 99% respectively), pericardial effusion (91% and 94% respectively), and intra-abdominal free fluid (74% and 98% respectively). Sub-group analysis was completed for detection of intra-abdominal free fluid in hypotensive (sensitivity 74% and specificity 95%), adult normotensive (sensitivity 76% and specificity 98%) and pediatric patients (sensitivity 71% and specificity 95%).ConclusionsOur systematic review and meta-analysis suggests that e-FAST is a useful bedside tool for ruling in pneumothorax, pericardial effusion, and intra-abdominal free fluid in the trauma setting. Its usefulness as a rule-out tool is not supported by these results.

The reliability of clinical examination in detecting pelvic fractures in blunt trauma patients: a meta-analysis

2004 ◽  
Vol 124 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Stefan Sauerland ◽  
Bertil Bouillon ◽  
Dieter Rixen ◽  
Marcus R. Raum ◽  
Timmo Koy ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Clinical Examination ◽  
Meta Analysis ◽  
Pelvic Fractures ◽  
Trauma Patients
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