{"title":"Diagnostic Accuracy of Ultrasonography for Identification of Elbow Fractures in Children; a Systematic Review and Meta-analysis.","authors":"Seyed Mehdi Hosseini Khameneh, Reza Amani-Beni, Seyed-Amirabbas Ahadiat, Mohammad Saeed Kahrizi, Sina Jafari, Seyedehatefe Seyedinnavade, Amir Masood Rafie Manzelat, Noushin Mashatan, Dorsa Beheshtiparvar, Atousa Moghadam Fard, Hamed Lotfi, Hossein Arhami, Reza Barati, Raziyeh Hasanvand, Shima Boorboor, Elaheh Khodaei, Dorsa Dadashzadehasl, Fatemeh Zamani, Roya Khorram, Maryam Ebrahimpour, Zeynab Abdollahi, Mohammadreza Shabani, Nariman Latifi, Reza Vafadar, Sepideh Shah Hosseini, Mehran Khodashenas, Seyyed Morteza Kazemi, Reza Minaei Noshahr, Hani Ghayyem, Alireza Farahani, Diba Saeidi, Sajedeh Jadidi, Babak Goodarzy, Mehrdad Farrokhi","doi":"10.22037/aaem.v11i1.2078","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>In spite of the results of previous studies regarding the benefits of ultrasonography for diagnosis of elbow fractures in children, the exact accuracy of this imaging modality is still under debate. Therefore, in this diagnostic systematic review and meta-analysis, we aimed to investigate the accuracy of ultrasonography in this regard.</p><p><strong>Methods: </strong>Two independent reviewers performed systematic search in Web of Science, Embase, PubMed, Cochrane, and Scopus for studies published from inception of these databases to May 2023. Quality assessment of the included studies was performed using Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Meta-Disc software version 1.4 and Stata statistical software package version 17.0 were used for statistical analysis.</p><p><strong>Results: </strong>A total of 648 studies with 1000 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.95 (95% CI: 0.93-0.97) and 0.87 (95% CI: 0.84-0.90), respectively. Pooled positive likelihood ratio (PLR) was 6.71 (95% CI: 3.86-11.67), negative likelihood ratio (NLR) was 0.09 (95% CI: 0.03-0.22), and pooled diagnostic odds ratio (DOR) of ultrasonography in detection of elbow fracture in children was 89.85 (95% CI: 31.56-255.8). The area under the summary receiver operating characteristic (ROC) curve for accuracy of ultrasonography in this regard was 0.93. Egger's and Begg's analyses showed that there is no significant publication bias (P=0.11 and P=0.29, respectively).</p><p><strong>Conclusion: </strong>Our meta-analysis revealed that ultrasonography is a relatively promising diagnostic imaging modality for identification of elbow fractures in children. However, clinicians employing ultrasonography for diagnosis of elbow fractures should be aware that studies included in this meta-analysis had limitations regarding methodological quality and are subject to risk of bias. Future high-quality studies with standardization of ultrasonography examination protocol are required to thoroughly validate ultrasonography for elbow fractures.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e62"},"PeriodicalIF":2.9000,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/a2/aaem-11-e62.PMC10568949.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Academic Emergency Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.22037/aaem.v11i1.2078","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: In spite of the results of previous studies regarding the benefits of ultrasonography for diagnosis of elbow fractures in children, the exact accuracy of this imaging modality is still under debate. Therefore, in this diagnostic systematic review and meta-analysis, we aimed to investigate the accuracy of ultrasonography in this regard.
Methods: Two independent reviewers performed systematic search in Web of Science, Embase, PubMed, Cochrane, and Scopus for studies published from inception of these databases to May 2023. Quality assessment of the included studies was performed using Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Meta-Disc software version 1.4 and Stata statistical software package version 17.0 were used for statistical analysis.
Results: A total of 648 studies with 1000 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.95 (95% CI: 0.93-0.97) and 0.87 (95% CI: 0.84-0.90), respectively. Pooled positive likelihood ratio (PLR) was 6.71 (95% CI: 3.86-11.67), negative likelihood ratio (NLR) was 0.09 (95% CI: 0.03-0.22), and pooled diagnostic odds ratio (DOR) of ultrasonography in detection of elbow fracture in children was 89.85 (95% CI: 31.56-255.8). The area under the summary receiver operating characteristic (ROC) curve for accuracy of ultrasonography in this regard was 0.93. Egger's and Begg's analyses showed that there is no significant publication bias (P=0.11 and P=0.29, respectively).
Conclusion: Our meta-analysis revealed that ultrasonography is a relatively promising diagnostic imaging modality for identification of elbow fractures in children. However, clinicians employing ultrasonography for diagnosis of elbow fractures should be aware that studies included in this meta-analysis had limitations regarding methodological quality and are subject to risk of bias. Future high-quality studies with standardization of ultrasonography examination protocol are required to thoroughly validate ultrasonography for elbow fractures.
引言：尽管先前的研究结果表明超声检查对诊断儿童肘部骨折有好处，但这种成像方式的确切准确性仍存在争议。因此，在本诊断系统综述和荟萃分析中，我们旨在研究超声在这方面的准确性。方法：两名独立评审员在Web of Science、Embase、PubMed、Cochrane和Scopus上对从这些数据库成立到2023年5月发表的研究进行了系统搜索。使用诊断准确性研究质量评估工具（QUADAS-2）对纳入的研究进行质量评估。Meta-Disc软件版本1.4和Stata统计软件包版本17.0用于统计分析。结果：共有648项研究纳入荟萃分析，涉及1000名患者。合并的敏感性和特异性分别为0.95（95%CI:0.93-0.97）和0.87（95%CI:0.84-0.90）。合并阳性似然比（PLR）为6.71（95%CI:3.86-11.67），阴性似然比（NLR）为0.09（95%CI:0.03-0.22），超声检查儿童肘部骨折的合并诊断优势比（DOR）为89.85（95%CI:31.56-255.8）。在这方面，超声检查准确性的总结受试者操作特征（ROC）曲线下面积为0.93。Egger和Begg的分析表明，没有显著的发表偏倚（分别为P=0.11和P=0.29）。结论：我们的荟萃分析表明，超声检查是一种相对有前途的诊断儿童肘部骨折的成像方式。然而，使用超声诊断肘部骨折的临床医生应该意识到，纳入该荟萃分析的研究在方法质量方面存在局限性，并且存在偏倚风险。未来需要对超声检查方案进行标准化的高质量研究，以彻底验证超声检查对肘部骨折的疗效。
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