横断面成像检测儿童急性舟骨骨折的诊断准确性：一项系统评价
The diagnostic accuracy of cross-sectional imaging for detecting acute scaphoid fractures in children: a systematic review.
作者信息
Offiah Amaka C, Burke Derek
机构信息
1 Department of Oncology and Metabolism, Academic Unit of Child Health, University of Sheffield, Damer Street Building, Sheffield Children's NHS Foundation Trust, Western Bank , Sheffield, S10 2TH , UK.
2 Department of Radiology, Sheffield Children's NHS Foundation Trust, Western Bank Library , Sheffield , UK.
出版信息
Br J Radiol. 2018 Jun;91(1086):20170883. doi: 10.1259/bjr.20170883. Epub 2018 Mar 13.
OBJECTIVE
To determine the diagnostic accuracy of cross-sectional imaging for the diagnosis of acute scaphoid fractures in children.
METHODS
A systematic review of Medline, Embase and Cochrane databases between 1980 and July 2017 was independently performed by two observers. Criteria for study inclusion in a meta-analysis and assessment of the quality of such studies using the QADAS tool, were predetermined.
RESULTS
No studies were eligible for inclusion in a meta-analysis. Three studies (of low quality when assessed against the STARD guidelines for reporting of studies of diagnostic accuracy) assessed MRI (performed between Days 2 and 10 after acute injury) for the diagnosis of scaphoid fractures in a total of 119 children (age range 6 to 16 years). Study 1 (45 children) reported inter-observer reliability of radiographs and MRI of 0.53 and 0.95 respectively. Study 3 (18 children) reported a negative predictive value of MRI (even as early as Day 2), of 100%. No measure of diagnostic accuracy or observer reliability was reported in Study 2 (56 children). In all 3 studies, MRI identified more scaphoid fractures (and other carpal injuries) than radiographs. Study 3 showed that follow-up MRI between Days 38 and 45 added no new information compared to initial MRI.
CONCLUSION
Based on a systematic review of the literature, there is currently no evidence on which to suggest an imaging protocol for suspected scaphoid fracture in children. Until such evidence is available, existing guidelines (which are based on findings from adult studies) should be followed. Advances in knowledge: (1) There is low quality evidence regarding the diagnostic accuracy of cross-sectional imaging for suspected scaphoid fractures in children and no evidence on which to propose an optimal imaging strategy. (2) Until such evidence is available, current guidelines (based predominantly on findings in adults and expert opinion) should be followed.
目的
确定横断面成像对儿童急性舟状骨骨折诊断的准确性。
方法
两名观察者独立对1980年至2017年7月期间的Medline、Embase和Cochrane数据库进行系统评价。预先确定纳入荟萃分析的研究标准以及使用QADAS工具评估此类研究的质量。
结果
没有研究符合纳入荟萃分析的条件。三项研究（根据诊断准确性研究报告的STARD指南评估质量较低）评估了MRI（在急性损伤后第2天至第10天进行）对总共119名儿童（年龄范围6至16岁）舟状骨骨折的诊断。研究1（45名儿童）报告X线片和MRI的观察者间可靠性分别为0.53和0.95。研究3（18名儿童）报告MRI的阴性预测值（甚至早在第2天）为100%。研究2（56名儿童）未报告诊断准确性或观察者可靠性的测量值。在所有三项研究中，MRI比X线片发现更多的舟状骨骨折（和其他腕骨损伤）。研究3表明，与初始MRI相比，第38天至第45天的随访MRI未提供新信息。
结论
基于对文献的系统评价，目前没有证据表明儿童疑似舟状骨骨折的成像方案。在获得此类证据之前，应遵循现有指南（这些指南基于成人研究结果）。知识进展：（1）关于横断面成像对儿童疑似舟状骨骨折诊断准确性的证据质量较低，且没有证据提出最佳成像策略。（2）在获得此类证据之前，应遵循当前指南（主要基于成人研究结果和专家意见）。
Zotero 插件