Diagnostic Radiology Department, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK.
Eur Radiol. 2021 Sep;31(9):7088-7097. doi: 10.1007/s00330-021-07775-3. Epub 2021 Mar 16.
To assess the diagnostic performance of chest CT in the detection of rib fractures in children investigated for suspected physical abuse (SPA).
Medline, Web of Science and Cochrane databases were searched from January 1980 to April 2020. The QUADAS-2 tool was used to assess the quality of the eligible English-only studies following which a formal narrative synthesis was constructed. Studies reporting true-positive, false-positive, true-negative, and false-negative results were included in the meta-analysis. Overall sensitivity and specificity of chest CT for rib fracture detection were calculated, irrespective of fracture location, and were pooled using a univariate random-effects meta-analysis. The diagnostic accuracy of specific locations along the rib arc (anterior, lateral or posterior) was assessed separately.
Of 242 identified studies, 4 met the inclusion criteria. Of these, 2 were included in the meta-analysis. Chest CT identified 142 rib fractures compared to 79 detected by initial skeletal survey chest radiographs in live children with SPA. Post-mortem CT (PMCT) has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures when compared to the autopsy reference standard. PMCT has low sensitivity (45%, 21% and 42%) but high specificity (99%, 97% and 99%) at anterior, lateral and posterior rib locations, respectively.
Chest CT detects more rib fractures than initial skeletal survey chest radiographs in live children with SPA. PMCT has low sensitivity but high specificity for detecting rib fractures in children investigated for SPA.
• PMCT has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures; extrapolation to CT in live children is difficult. • No studies have compared chest CT with the current accepted practice of initial and follow-up skeletal survey chest radiographs in the detection of rib fractures in live children investigated for SPA.
评估胸部 CT 在疑似躯体虐待（SPA）患儿肋骨骨折检测中的诊断性能。
检索了 1980 年 1 月至 2020 年 4 月期间的 Medline、Web of Science 和 Cochrane 数据库。使用 QUADAS-2 工具评估符合条件的英语研究的质量，然后进行正式的叙述性综合分析。纳入了报告真阳性、假阳性、真阴性和假阴性结果的研究。使用单变量随机效应荟萃分析计算了胸部 CT 对肋骨骨折检测的总体敏感性和特异性，而不论骨折位置如何。单独评估了肋骨弧特定部位（前、侧或后）的诊断准确性。
在 242 项已识别的研究中，有 4 项符合纳入标准。其中，有 2 项被纳入荟萃分析。与 SPA 活儿童初始骨骼调查胸片相比，胸部 CT 共发现 142 处肋骨骨折，而后者仅发现 79 处。与尸检参考标准相比，死后 CT（PMCT）在检测 SPA 患儿肋骨骨折时具有较低的敏感性（34%），但具有较高的特异性（99%）。PMCT 在检测前、侧和后侧肋骨骨折时，敏感性分别为 45%、21%和 42%，特异性分别为 99%、97%和 99%。
与 SPA 活儿童初始骨骼调查胸片相比，胸部 CT 能检测到更多的肋骨骨折。PMCT 在检测 SPA 患儿肋骨骨折时具有较低的敏感性，但特异性较高。
PMCT 检测肋骨骨折的敏感性（34%）较低，但特异性（99%）较高；难以将其外推到 SPA 活儿童的 CT 检查。
没有研究比较过胸部 CT 与目前 SPA 活儿童疑似肋骨骨折检测中初始和随访骨骼调查胸片的公认实践。
