Abstract
Objective
Ultrasound has an excellent diagnostic accuracy for fractures that is reportedly comparable
to plain radiographs. We aim to summarize the diagnostic accuracy of ultrasound for
upper extremity fractures in children.
Methods
Databases were searched from inception through November 2019 using pre-defined index
terms, including “ultrasound,” “fractures of upper extremities” and “children”. The
study is reported using Preferred Reporting Items for a Systematic Review and Meta-analysis
of Diagnostic Test Accuracy Studies (PRISMA-DTA). Meta-analysis of the diagnostic
accuracy of ultrasound for fractures was conducted using the random-effects bivariate
model. Subgroup analysis of fracture site (elbow vs non-elbow fractures) was also
performed. Meta-regression was performed to determine if the site of fracture affected
the diagnostic accuracy.
Results
Thirty-two studies were identified in the meta-analysis. Ultrasound for fractures
of the upper extremities has a sensitivity: 0.95 (95% CI: 0.93–0.97), specificity:
0.95 (95% CI: 0.91–0.98), positive likelihood ratio: 21.1 (95% CI: 10.8–41.5) and
negative likelihood ratio: 0.05 (95% CI: 0.03–0.07), with an area under ROC (AUROC)
curve of 0.98 (95% CI: 0.97–0.99). Subgroup analysis for elbow fracture showed ultrasound
has a sensitivity: 0.95 (95% CI: 0.86–0.98), specificity: 0.87 (95% CI: 0.76–0.94),
positive likelihood ratio: 7.3 (95% CI: 3.7–14.4) and negative likelihood ratio: 0.06
(95% CI: 0.02–0.16), with an AUROC of 0.96 (95% CI: 0.94–0.97). Meta-regression suggested
the fracture sites would affect diagnostic accuracy of ultrasound (elbow vs non-elbow,
p < 0.01).
Conclusions
Current evidence suggests ultrasound has excellent diagnostic accuracy for non-elbow
upper extremity fractures in children, serving as an alternative diagnostic modality
to plain radiographs.
Abbreviations:
POCUS (point-of-care ultrasound), RADUS (radiology-performed ultrasound)Keywords
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Article Info
Publication History
Published online: April 27, 2020
Accepted:
April 20,
2020
Received in revised form:
April 20,
2020
Received:
October 3,
2019
Publication stage
In Press Journal Pre-ProofFootnotes
☆Table of contents summary: This meta-analysis suggests ultrasound by clinicians has a high diagnostic accuracy for non-elbow upper extremity fractures in children.
☆What's Known on This Subject: Ultrasound has high diagnostic accuracy for fractures in adult, but it is unclear if ultrasound has similar accuracy in children. Furthermore, it is unknown if the site of fracture of the upper extremity affects the performance of sonographers.
☆What this study adds: This meta-analysis of 26 studies found that ultrasound has excellent diagnostic accuracy for non-elbow upper extremity fractures in children, but diagnostic accuracy is inferior in elbow fractures as compared to non-elbow fractures.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
