Archives of Academic Emergency Medicine (Sep 2023)

Diagnostic Accuracy of Ultrasonography for Identification of Elbow Fractures in Children; a Systematic Review and Meta-analysis

  • Seyed Mehdi Hosseini Khameneh,
  • Reza Amani-Beni,
  • Seyed-Amirabbas Ahadiat,
  • Mohammad Saeed Kahrizi,
  • Sina Jafari,
  • Seyedehatefe Seyedinnavade,
  • Amir Masood Rafie Manzelat,
  • Noushin Mashatan,
  • Dorsa Beheshtiparvar,
  • Atousa Moghadam Fard,
  • Hamed Lotfi,
  • Hossein Arhami,
  • Reza Barati,
  • Raziyeh Hasanvand,
  • Shima Boorboor,
  • Elaheh Khodaei,
  • Dorsa Dadashzadehasl,
  • Fatemeh Zamani,
  • Roya Khorram,
  • Maryam Ebrahimpour,
  • Zeynab Abdollahi,
  • Mohammadreza Shabani,
  • Nariman Latifi,
  • Reza Vafadar,
  • Sepideh Shah Hosseini,
  • Mehran Khodashenas,
  • Seyyed Morteza Kazemi,
  • Reza Minaei Noshahr,
  • Hani Ghayyem,
  • Alireza Farahani,
  • Diba Saeidi,
  • Sajedeh Jadidi,
  • Babak Goodarzy,
  • Mehrdad Farrokhi

DOI
https://doi.org/10.22037/aaem.v11i1.2078
Journal volume & issue
Vol. 11, no. 1

Abstract

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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.

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