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Abstract
Evidence shows that tissue sample culturing is the gold standard approach for diagnosing fracture-related infection (FRI). Sonication fluid sampling has also been reported to be efficacious and superior to tissue sample culturing with prosthetic joint infection. However, data from the current literature are not enough to validate this hypothesis for FRI. We conducted a meta-analysis to validate the diagnostic accuracy of tissue sample culturing and sonication fluid aspiration and to find which one is superior to the other. An extensive search through the relevant databases was conducted to obtain all the relevant studies. We have included 13 relevant studies, including nine retrospective cohorts and four prospective ones. The overall pooled estimates of sensitivity, specificity, and diagnostic odds ratio (DOR) of tissue sampling culture in diagnosing fracture-related infections were 98% (95% CI, 92% to 99%), 38% (95% CI, 23% to 56%), and 25 (4 to 154), respectively. The overall pooled estimates of sensitivity, specificity, and DOR of sonication fluid sample culture in diagnosing fracture-related infections were 86% (95% CI, 79% to 92%), 98% (95% CI, 93% to 100%), and 353 (78 to 1598), respectively. No significant risk of bias was found regarding the sensitivity and specificity among studies investigating both modalities, however, significant heterogeneity was noticed. Sonication fluid sampling can be used to confirm FRI while tissue sampling can be used to exclude it and both modalities should be combined for obtaining the most accurate outcome.
Highlights
BackgroundComplications following bone trauma are relatively common and constitute around 14% [1]
The summary receiver operating characteristic (SROC) plot showed an area under the curve (AUC) of 84% (Figure 5)
The overall pooled estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of sonication fluid sample culture in diagnosing fracture-related infections were 86%, 98%, 49.1, 0.14, and 353 (78 to 1598), respectively (Table 2; Figure 10)
Summary
Complications following bone trauma are relatively common and constitute around 14% [1]. Previous estimates show that the occurrence of fracture-related bone infections (FRI) and osteomyelitis are relatively common following 1% closed fractures and around 10%-30% open fractures [2,3,4]. We think that a diagnostic meta-analysis would be useful for the validation of tissue-culture and sonication fluid sampling in the detection of FRI based on previous and recent data. How to cite this article Ahmed E A, Almutairi M K, Alkaseb A T (May 09, 2021) Accuracy of Tissue and Sonication Fluid Sampling for the Diagnosis of Fracture-Related Infection: Diagnostic Meta-Analysis. We excluded studies with any of the following: 1) no history of fractures; 2) diagnostic accuracy measures were not reported; 3) in vitro or non-human subjects; 4) duplicate/overlapped data; 5) abstractonly/conference articles, books, dissertations, reviews, editorials, letters, author responses, and comments.
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