Leeds Institute for Medical Research, University of Leeds, Leeds, UK.
Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
Syst Rev. 2022 Aug 20;11(1):173. doi: 10.1186/s13643-022-02037-9.
Early and accurate clinical diagnosis of the extent of obstetric brachial plexus injury (OBPI) is challenging. The current gold standard for delineating the nerve injury is surgical exploration, and synchronous reconstruction is performed if indicated. Magnetic resonance imaging (MRI) is a non-invasive method of assessing the anatomy and severity of nerve injury in OBPI but the diagnostic accuracy is unclear. The primary objective of this review is to determine the diagnostic accuracy of MRI in comparison to surgical brachial plexus exploration for detecting root avulsion in children under 5 with OBPI. The secondary objectives are to determine its' diagnostic accuracy for detecting nerve abnormality and detecting pseudomeningocele(s) in this group.
This review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).We will include studies reporting the accuracy of MRI (index test) compared to surgical exploration (reference standard) in detecting any of the three target conditions (root avulsion, any nerve abnormality and pseudomeningocele) in children under five with OBPI. Case reports and studies where the number of true positives, false positives, true negatives and false negatives cannot be derived will be excluded. We plan to search PubMed, Embase and CENTRAL for relevant studies from database inception to 15 June 2022. We will also search grey literature (medRxiv, bioRxiv and Google Scholar) and perform forward and backward citation chasing. Screening and full-text assessment of eligibility will be conducted by two independent reviewers, who will then both extract the relevant data. The QUADAS-2 tool will be used to assess methodological quality and risk of bias of included studies by two reviewers independently. The following test characteristics for the target conditions will be extracted: true positives, false positives, true negatives and false negatives. Estimates of sensitivity and specificity with 95% confidence intervals will be shown in forest plots for each study. If appropriate, summary sensitivities and specificities for target conditions will be obtained via meta-analyses using a bivariate model.
This study will aim to clarify the diagnostic accuracy of MRI for detecting nerve injury in OBPI and define its clinical role.
PROSPERO CRD42021267629.
早期准确诊断产科臂丛神经损伤（OBPI）具有挑战性。目前界定神经损伤的金标准是手术探查，如果有必要，同时进行同步重建。磁共振成像（MRI）是评估 OBPI 中神经损伤解剖结构和严重程度的一种非侵入性方法，但诊断准确性尚不清楚。本研究的主要目的是确定 MRI 与外科臂丛神经探查相比，在检测 5 岁以下 OBPI 患儿神经根撕脱方面的诊断准确性。次要目的是确定其在检测该组神经异常和检测假性脑膜膨出方面的诊断准确性。
本综述将按照系统评价和荟萃分析的首选报告项目（PRISMA）进行。我们将纳入报告 MRI（指标试验）与外科探查（参考标准）相比，在检测 5 岁以下 OBPI 儿童任何三种目标情况（神经根撕脱、任何神经异常和假性脑膜膨出）中的准确性的研究。将排除无法得出真阳性、假阳性、真阴性和假阴性数量的病例报告和研究。我们计划从数据库开始到 2022 年 6 月 15 日，在 PubMed、Embase 和 CENTRAL 中搜索相关研究。我们还将检索灰色文献（medRxiv、bioRxiv 和 Google Scholar）并进行前向和后向引用追踪。两名独立审查员将进行筛选和全文评估，并提取相关数据。使用 QUADAS-2 工具由两名审查员独立评估纳入研究的方法学质量和偏倚风险。将为目标条件提取以下测试特征：真阳性、假阳性、真阴性和假阴性。将为每个研究显示以 95%置信区间表示的估计敏感性和特异性的森林图。如果合适，将通过使用双变量模型的荟萃分析获得目标条件的汇总敏感性和特异性。
本研究旨在阐明 MRI 检测 OBPI 中神经损伤的诊断准确性，并确定其临床作用。
PROSPERO CRD42021267629。
