Abstract
Study ObjectiveTo determine the diagnostic accuracy of ultrasound for detecting distal forearm fractures.MethodsA systematic review and diagnostic meta-analysis was performed according to the PRISMA statement. We searched MEDLINE, Web of Science and the Cochrane Library from inception to September 2015. All prospective studies of the diagnostic accuracy of ultrasound versus radiography as the reference standard were included. We excluded studies with a retrospective design and those with evidence of verification bias. We assessed the methodological quality of the included studies with the QUADAS-2 tool. We performed a meta-analysis of studies evaluating ultrasound to calculate the pooled sensitivity and specificity with 95% confidence intervals (CI95%) using a bivariate model with random effects. Subgroup and sensitivity analysis were used to examine the effect of methodological differences and other study characteristics.ResultsOut of 867 publications we included 16 studies with 1,204 patients and 641 fractures. The pooled test characteristics for ultrasound were: sensitivity 97% (CI95% 93–99%), specificity 95% (CI95% 89–98%), positive likelihood ratio (LR) 20.0 (8.5–47.2) and negative LR 0.03 (0.01–0.08). The corresponding pooled diagnostic odds ratio (DOR) was 667 (142–3,133). Apparent differences were shown for method of viewing, with the 6-view method showing higher specificity, positive LR, and DOR, compared to the 4-view method.ConclusionThe present meta-analysis showed that ultrasound has a high accuracy for the diagnosis of distal forearm fractures in children when used by proper viewing method. Based on this, ultrasound should be considered a reliable alternative, which has the advantages of being radiation free.
Highlights
Distal forearm fractures are common both in adults and the paediatric age group
Apparent differences were shown for method of viewing, with the 6-view method showing higher specificity, positive likelihood ratio (LR), and diagnostic odds ratio (DOR), compared to the 4-view method
The present meta-analysis showed that ultrasound has a high accuracy for the diagnosis of distal forearm fractures in children when used by proper viewing method
Summary
Distal forearm fractures are common both in adults and the paediatric age group. In the latter group, these fractures are mostly localized extra-articular [1,2], in contrast to adults who are more likely to have an intra-articular component [3,4]. It has been suggested that ultrasound only provides additional value under special circumstances, like the pre hospital environment, disaster areas, developing countries, suspicion of occult fracture in poorly ossified bones, pregnant patients and to reduce exposure to serial direct radiographs in fracture reduction [23,24,25,26,27]. An important feature in this debate is the actual diagnostic accuracy of ultrasound for detecting forearm fractures
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