Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update.

Abstract Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, one described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15-100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26-55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85-100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73-100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively. Conclusions Only one study was found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

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Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2988-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Patrick Krastman ◽

Nina M. Mathijssen ◽

Sita M. A. Bierma-Zeinstra ◽

Gerald Kraan ◽

Jos Runhaar

Keyword(s):

Physical Examination ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Scaphoid Fracture ◽

Radiological Examination ◽

Supporting Evidence ◽

History Taking ◽

Wrist Fractures ◽

Scaphoid Fractures ◽

Work Up

Abstract Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13–98%, 55–73%, 14–73% and 75–100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13–89%, 45–76%, 41–77% and 63–75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79–100%, 49–100% and 86–97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78–100%, 70–100%, 79–100% and 70–100%, respectively. Conclusions Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

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Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update.

10.21203/rs.2.14566/v2 ◽

2019 ◽

Author(s):

Patrick Krastman ◽

Nina M. Mathijssen ◽

Sita M.A. Bierma-Zeinstra ◽

Gerald Kraan ◽

Jos Runhaar

Keyword(s):

Physical Examination ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Scaphoid Fracture ◽

Radiological Examination ◽

Supporting Evidence ◽

History Taking ◽

Wrist Fractures ◽

Scaphoid Fractures ◽

Work Up

Abstract Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15-100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26-55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85-100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73-100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively. Conclusions Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

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Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update.

10.21203/rs.2.14566/v4 ◽

2019 ◽

Author(s):

Patrick Krastman ◽

Nina M. Mathijssen ◽

Sita M.A. Bierma-Zeinstra ◽

Gerald Kraan ◽

Jos Runhaar

Keyword(s):

Physical Examination ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Scaphoid Fracture ◽

Radiological Examination ◽

Supporting Evidence ◽

History Taking ◽

Wrist Fractures ◽

Scaphoid Fractures ◽

Work Up

Abstract Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15-100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26-55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85-100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73-100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively. Conclusions Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

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Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update

BMJ Open ◽

10.1136/bmjopen-2020-037810 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037810

Author(s):

Patrick Krastman ◽

Nina M C Mathijssen ◽

Sita M A Bierma-Zeinstra ◽

Gerald A Kraan ◽

Jos Runhaar

Keyword(s):

Physical Examination ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Tendon Injuries ◽

Cochrane Library ◽

Supporting Evidence ◽

History Taking ◽

Triangular Fibrocartilage ◽

Diagnostic Work ◽

Wrist Ligament

ObjectiveThe diagnostic work-up for ligament and tendon injuries of the finger, hand and wrist consists of history taking, physical examination and imaging if needed, but the supporting evidence is limited. The main purpose of this study was to systematically update the literature for studies on the diagnostic accuracy of tests for detecting non-chronic ligament and tendon injuries of the finger, hand and wrist.MethodsMedline, Embase, Cochrane Library, Web of Science, Google Scholar ProQuest and Cinahl were searched from 2000 up to 6 February 2019 for identifying studies. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist, and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted.ResultsNone of the studies involved history taking. Physical examination, for diagnosing lesions of the triangular fibrocartilage complex (TFCC), showed Se, Sp, accuracy, PPV and NPV ranging from 58% to 90%, 20% to 69%, 56% to 73%, 53% to 71% and 55% to 65%, respectively. Physical examination in hand and finger injuries the Se, Sp, accuracy, PPV and NPV ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. The accuracy of MRI with high-resolution (3 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 89% to 91% and 75% to 100%, respectively. The accuracy of MRI with low-resolution (1.5 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 81% to 100% and 67% to 95%, respectively.ConclusionsThere is limited evidence on the diagnostic accuracy of history taking and physical examination for non-chronic finger, hand and wrist ligament and tendon injuries. Although some imaging modalities seemed to be acceptable for the diagnosis of ligament and tendon injuries in the wrist in patients presenting to secondary care, there is no evidence-based advise possible for the diagnosis of non-chronic finger, hand or wrist ligament and tendon injuries in primary care.

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Diagnostic Performance and Advanced Imaging Reduction With Digital Tomosynthesis in Scaphoid Fracture Management

Hand ◽

10.1177/1558944720988120 ◽

2021 ◽

pp. 155894472098812

Author(s):

Eric Perloff ◽

Keegan Cole ◽

Sarah Sternbach ◽

Andrew Rosenbaum ◽

David Quinn

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Imaging Modality ◽

Scaphoid Fracture ◽

Digital Tomosynthesis ◽

Occult Fracture ◽

Advanced Imaging ◽

Scaphoid Fractures ◽

Plain Films ◽

Fracture Management

Background Management of scaphoid fractures often requires advanced imaging to achieve accurate diagnoses and appropriate treatment. Digital tomosynthesis (DTS) is a cross-sectional imaging modality that may be used to substitute magnetic resonance imaging or computed tomographic scans. The purpose of this study is to: (1) determine the diagnostic accuracy of DTS in occult scaphoid fractures; and (2) report on the reduction of other advanced imaging when using DTS. Methods From May 2014 to October 2017, the charts of all patients who underwent scaphoid tomogram were retrospectively reviewed. The diagnostic accuracy of DTS for occult fracture was compared with 2-week follow-up plain films. To measure the reduction in utilization of advanced imaging, it was determined whether DTS eliminated the need for advanced imaging by providing adequate information regarding the clinical question. Results A total of 78 patients underwent scaphoid tomography in this time frame: 39 for occult fracture, 33 for fracture union, 5 for fracture morphology, and 1 for hardware positioning. For the detection of occult fracture, DTS had a sensitivity of 100%, specificity of 83%, positive predictive value of 64%, and negative predictive value of 100%. Advanced imaging was not used in 35 of the remaining 39 patients based on the results obtained by DTS. In patients who did receive advanced imaging, 83% of tomograms provided conclusive diagnostic information. Conclusions Digital tomosynthesis increases the diagnostic sensitivity of occult scaphoid fractures, reducing unnecessary immobilization and advanced imaging. Digital tomosynthesis provides clinical detail beyond plain film, which reduces the need to obtain advanced imaging when assessing union, fracture pattern, and hardware placement.

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Predictive value of history taking and physical examination in diagnosing arrhythmias in general practice

Family Practice ◽

10.1093/fampra/cmm056 ◽

2007 ◽

Vol 24 (6) ◽

pp. 636-641 ◽

Cited By ~ 12

Author(s):

E. Hoefman ◽

K. R Boer ◽

H. C. van Weert ◽

J. B Reitsma ◽

R. W Koster ◽

...

Keyword(s):

General Practice ◽

Physical Examination ◽

Predictive Value ◽

History Taking

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Comparative Accuracy of Ultrasound and Physical Examination Conducted by Clinical Year Medical Students in Diagnosing Ascites

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.s01.12140 ◽

2021 ◽

Vol 104 (Suppl. 1) ◽

pp. S25-S29

Keyword(s):

Medical Students ◽

Physical Examination ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Clinical Decision Making ◽

Medical Curriculum ◽

Training Session ◽

Confidence Score ◽

Ease Of Use ◽

Post Intervention

Background: Accurate diagnosis of ascites is crucial before abdominal paracentesis can be performed. Physical examination alone can be inaccurate and lead to incorrect clinical decision making. Objective: We aimed to evaluate and compare the accuracy of physical examination and ultrasound conducted by clinical year medical students after short ultrasound training session. Materials and Methods: This was a prospective quasi experimental study conducted from January 2020 to April 2020. The sample consisted of 18 clinical-year medical students at Srinagarind Hospital Emergency Department. Ultrasound training (intervention) was provided by one specialist in emergency ultrasound. Five volunteer patients were evaluated for ascites using two modalities (physical examination [PE; pre-intervention] and ultrasound [post-intervention]). Participants then responded to a questionnaire constructed to evaluate the relative ease of use of each modality as well as students’ confidence and satisfaction. Data were compared using the McNemar test, and p<0.05 was considered statistically significant. Results: Eighteen medical students were included. Participants were able to diagnose ascites in the five patient volunteers using PE with a sensitivity of 74.2%, specificity of 94.4%, positive predictive value (PPV) of 95.2%, and negative predictive value (NPV) of 70.8%. Subsequent ultrasound examination yielded a sensitivity of 90.7%, specificity of 97.2%, PPV of 98%, and NPV of 87.5%. Use of ultrasound increased diagnostic accuracy from 82.2% to 93.3% and yielded higher mean ease and satisfaction scores. However, the average confidence score was lower and time required to perform the procedure was longer. Conclusion: Medical students were able learn to use an ultrasound device after a short training session with an expert. Ultrasound yielded higher diagnostic accuracy for ascites. Future studies should be conducted regarding the inclusion of ultrasound training programs in medical education curricula. Keywords: Ultrasound, Ascites, Emergency medicine, Medical curriculum

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Rehabilitation psychiatry: description of a provincial setting in Zimbabwe

Psychiatric Bulletin ◽

10.1192/pb.14.9.552 ◽

1990 ◽

Vol 14 (9) ◽

pp. 552-554 ◽

Cited By ~ 1

Author(s):

Paul Sidandi

Keyword(s):

Physical Examination ◽

Ct Scanning ◽

Psychiatric Services ◽

History Taking ◽

X Ray ◽

System A ◽

British System ◽

Work Up ◽

State Examination ◽

Routine Investigations

Psychiatric services in Zimbabwe are, by African standards, relatively sophisticated and are modelled on the British system. A new patient is assessed using the Maudsley history-taking format modified to suit local situations, and a mental state examination. A physical examination and routine investigations follow. X-ray facilities and basic laboratory work-up such as haematology and microscopy are available at Provincial level. EEG, ultrasonography, echoencephalography, CT scanning and serum anticonvulsant levels are available in Harare and Bulawayo.

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