Diagnostic Performance of Ultrasonography for Detection of Pediatric Elbow Fracture: A Meta-analysis - 19/09/19
Abstract |
Study objective |
We evaluate the diagnostic performance of ultrasonography for detection of elbow fracture in pediatric patients with trauma.
Methods |
PubMed and EMBASE databases were searched for diagnostic accuracy studies that used ultrasonography for detection of elbow fracture in pediatric patients. Bivariate modeling and hierarchic summary receiver operating characteristic (ROC) modeling were conducted to evaluate diagnostic performance. The pooled proportions of the false-negative rate were assessed with a DerSimonian-Laird random-effects model. We performed meta-regression analyses for heterogeneity exploration.
Results |
Ten articles involving a total of 519 patients were included. The summary sensitivity, summary specificity, and area under the hierarchic summary ROC curve were 96% (95% confidence interval 88% to 99%), 89% (95% confidence interval 82% to 94%), and 0.97 (95% confidence interval 0.95 to 0.98), respectively. The pooled proportion of the false-negative rate of ultrasonography was 3.7%. Among the various potential covariates, ultrasonographic performer (pediatric emergency physician versus others) and presence of extra musculoskeletal ultrasonographic training (trained versus not reported) were associated with heterogeneity of the specificity.
Conclusion |
Elbow ultrasonography demonstrated high performance in the diagnosis of pediatric elbow fracture, particularly in studies of physicians with extra training in musculoskeletal ultrasonography. Ultrasonography may be performed by trained physicians as a first-line diagnostic tool to diagnose pediatric elbow fracture.
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| Please see page 494 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Kelly D. Young, MD, MS. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: Both authors conceived the study, conducted online literature searches, and performed data extraction and quality assessment. SJY supervised the conduct of the trial and data collection and analyzed the data. SHL drafted the article, and both authors contributed substantially to its revision. SJY takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
Vol 74 - N° 4
P. 493-502 - octobre 2019 Retour au numéro
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