超声检查对儿童肘部骨折的诊断准确性：一项系统评价和Meta分析
Diagnostic Accuracy of Ultrasonography for Identification of Elbow Fractures in Children; a Systematic Review and Meta-analysis.
作者信息
Hosseini Khameneh Seyed Mehdi, Amani-Beni Reza, Ahadiat Seyed-Amirabbas, Kahrizi Mohammad Saeed, Jafari Sina, Seyedinnavade Seyedehatefe, Rafie Manzelat Amir Masood, Mashatan Noushin, Beheshtiparvar Dorsa, Moghadam Fard Atousa, Lotfi Hamed, Arhami Hossein, Barati Reza, Hasanvand Raziyeh, Boorboor Shima, Khodaei Elaheh, Dadashzadehasl Dorsa, Zamani Fatemeh, Khorram Roya, Ebrahimpour Maryam, Abdollahi Zeynab, Shabani Mohammadreza, Latifi Nariman, Vafadar Reza, Shah Hosseini Sepideh, Khodashenas Mehran, Kazemi Seyyed Morteza, Minaei Noshahr Reza, Ghayyem Hani, Farahani Alireza, Saeidi Diba, Jadidi Sajedeh, Goodarzy Babak, Farrokhi Mehrdad
机构信息
Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University ofMedical Sciences, Tehran, Iran.
School ofMedicine, Isfahan University ofMedical Sciences, Isfahan, Iran.
出版信息
Arch Acad Emerg Med. 2023 Sep 10;11(1):e62. doi: 10.22037/aaem.v11i1.2078. eCollection 2023.
INTRODUCTION
In spite of the results of previous studies regarding the benefits of ultrasonography for diagnosis of elbow fractures in children, the exact accuracy of this imaging modality is still under debate. Therefore, in this diagnostic systematic review and meta-analysis, we aimed to investigate the accuracy of ultrasonography in this regard.
METHODS
Two independent reviewers performed systematic search in Web of Science, Embase, PubMed, Cochrane, and Scopus for studies published from inception of these databases to May 2023. Quality assessment of the included studies was performed using Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Meta-Disc software version 1.4 and Stata statistical software package version 17.0 were used for statistical analysis.
RESULTS
A total of 648 studies with 1000 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.95 (95% CI: 0.93-0.97) and 0.87 (95% CI: 0.84-0.90), respectively. Pooled positive likelihood ratio (PLR) was 6.71 (95% CI: 3.86-11.67), negative likelihood ratio (NLR) was 0.09 (95% CI: 0.03-0.22), and pooled diagnostic odds ratio (DOR) of ultrasonography in detection of elbow fracture in children was 89.85 (95% CI: 31.56-255.8). The area under the summary receiver operating characteristic (ROC) curve for accuracy of ultrasonography in this regard was 0.93. Egger's and Begg's analyses showed that there is no significant publication bias (P=0.11 and P=0.29, respectively).
CONCLUSION
Our meta-analysis revealed that ultrasonography is a relatively promising diagnostic imaging modality for identification of elbow fractures in children. However, clinicians employing ultrasonography for diagnosis of elbow fractures should be aware that studies included in this meta-analysis had limitations regarding methodological quality and are subject to risk of bias. Future high-quality studies with standardization of ultrasonography examination protocol are required to thoroughly validate ultrasonography for elbow fractures.
引言
尽管先前有研究表明超声检查对儿童肘部骨折的诊断有益，但这种成像方式的确切准确性仍存在争议。因此，在这项诊断性系统评价和荟萃分析中，我们旨在研究超声检查在这方面的准确性。
方法
两名独立评审员在Web of Science、Embase、PubMed、Cochrane和Scopus数据库中进行了系统检索，以查找从这些数据库建立之初到2023年5月发表的研究。使用诊断准确性研究质量评估工具（QUADAS-2）对纳入研究进行质量评估。使用Meta-Disc软件版本1.4和Stata统计软件包版本17.0进行统计分析。
结果
荟萃分析共纳入648项研究，涉及1000名患者。合并敏感度和特异度分别为0.95（95%CI：0.93-0.97）和0.87（95%CI：0.84-0.90）。合并阳性似然比（PLR）为6.71（95%CI：3.86-11.67），阴性似然比（NLR）为0.09（95%CI：0.03-0.22），超声检查在儿童肘部骨折检测中的合并诊断比值比（DOR）为89.85（95%CI：31.56-255.8）。在这方面，超声检查准确性的汇总受试者工作特征（ROC）曲线下面积为0.93。Egger分析和Begg分析表明，不存在显著的发表偏倚（P分别为0.11和0.29）。
结论
我们的荟萃分析表明，超声检查是一种相对有前景的诊断成像方式，可用于识别儿童肘部骨折。然而，使用超声检查诊断儿童肘部骨折的临床医生应意识到，本荟萃分析中纳入的研究在方法学质量方面存在局限性，且存在偏倚风险。未来需要进行高质量的研究，对超声检查方案进行标准化，以全面验证超声检查对肘部骨折的诊断价值。
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