Tsou Po-Yang, Ma Yu-Kun, Wang Yu-Hsun, Gillon Jason T, Rafael John, Deanehan Julia K
Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Am J Emerg Med. 2021 Jun;44:383-394. doi: 10.1016/j.ajem.2020.04.071. Epub 2020 Apr 27.
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.
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.
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).
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.
超声对骨折具有出色的诊断准确性，据报道其与X线平片相当。我们旨在总结超声对儿童上肢骨折的诊断准确性。
从数据库建立至2019年11月，使用预定义的索引词进行检索，包括“超声”、“上肢骨折”和“儿童”。本研究按照诊断试验准确性研究的系统评价和Meta分析的首选报告项目（PRISMA-DTA）进行报告。采用随机效应双变量模型对超声诊断骨折的准确性进行Meta分析。还对骨折部位（肘部骨折与非肘部骨折）进行了亚组分析。进行Meta回归以确定骨折部位是否影响诊断准确性。
Meta分析共纳入32项研究。上肢骨折超声检查的敏感度为0.95（95%可信区间：0.93 - 0.97），特异度为0.95（95%可信区间：0.91 - 0.98），阳性似然比为21.1（95%可信区间：10.8 - 41.5），阴性似然比为0.05（95%可信区间：0.03 - 0.07），ROC曲线下面积（AUROC）为0.98（95%可信区间：0.97 - 0.99）。肘部骨折亚组分析显示，超声敏感度为0.95（95%可信区间：0.86 - 0.98），特异度为0.87（95%可信区间：0.76 - 0.94），阳性似然比为7.3（95%可信区间：3.7 - 14.4），阴性似然比为0.06（95%可信区间：0.02 - 0.16），AUROC为0.96（95%可信区间：0.94 - 0.97）。Meta回归提示骨折部位会影响超声的诊断准确性（肘部骨折与非肘部骨折，p＜0.01）。
目前的证据表明，超声对儿童非肘部上肢骨折具有出色的诊断准确性，可作为X线平片的替代诊断方法。
