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Ultrasonography in the diagnosis of pediatric distal forearm fracture: a systematic review

Ayman S. Ahmed

Ayman S. Ahmed

Emergency Medicine, The Rotherham NHS Foundation TrustRotherham, United Kingdom
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Ahmed, Ayman S.
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Ahmed E. Abdelhady

Ahmed E. Abdelhady

Emergency Medicine, East Jeddah Hospital, Ministry of HealthJeddah, Saudi Arabia
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Abdelhady, Ahmed E.
  
Nov 08, 2024
Ultrasonography in the diagnosis of pediatric distal forearm fracture: a systematic review's Cover Image
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Article Category: Research paper
Published Online: Nov 08, 2024
Page range: 1 - 8
Received: Sep 07, 2023
Accepted: Jan 17, 2024
DOI: https://doi.org/10.15557/jou.2024.0019
Keywords
© 2024 Ayman S. Ahmed et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

The PRISMA flow chart diagram for the results of the literature search and study selection
The PRISMA flow chart diagram for the results of the literature search and study selection

Fig. 2.

Forest plot showing the sensitivity and specificity of the included studies. CI – confidence interval; FN – false negative; FP – false positive; TN – true negative; TP – true positive
Forest plot showing the sensitivity and specificity of the included studies. CI – confidence interval; FN – false negative; FP – false positive; TN – true negative; TP – true positive

Fig. 3.

Hierarchical summary receiver operating characteristics (HSROC) curve for the diagnostic performance of bedside ultrasonography in the included studies
Hierarchical summary receiver operating characteristics (HSROC) curve for the diagnostic performance of bedside ultrasonography in the included studies

Characteristics of the included studies (n = 7)

Study Study design & settings No. participants/No. fractures Inclusion criteria Exclusion criteria
Patel et al.(21) Prospective cohort Single center in the USA March 2006 through January 2007 33/34 Age: 2 through 17 Suspected radius, ulna, tibia, or fibula fractures Open fractures Neurovascular compromise Hemodynamic instability Fractures involving joints
Ackermann et al.(16) Prospective diagnostic test study Single center in Germany January 2007 to May 2008 93/77 Age: 0–12 years Suspected closed forearm fracture Open wounds or deformity >30 Neural/vascular lesions requiring immediate operation
Chaar-Alvarez et al.(18) Prospective diagnostic test study Single center in the USA October 2007 to March 2009 101/46 Age: 1–17 years Nonangulated distal forearm injuries Normal neurovascular examination distal to the injury site. Clinical forearm deformity, open forearm wound Multisystem trauma Altered mental status, developmental delay Hemodynamic instability Previous radiography Allergy to US gel Extremity pain/swelling proximal or distal to the injured forearm
Barata et al.(17) Prospective diagnostic test study Single center in the USA March 2008 to January 2009 53/43 Age <18 years Suspected long-bone fracture. History of fracture Extremity deformity or open fracture Orthopedic hardware in the traumatized area
Eckert et al.(19) Prospective diagnostic test study Single center in Germany September 2009 to August 2010 76/52 Suspected distal forearm fracture Open injuries Significant deformity Neural &/or vascular lesions.
Herren et al.(20) Prospective diagnostic test study 2 centers in Germany January to December 2012 201/104 Age: up to 11 years Pain in the forearm area following trauma Open wounds in the distal forearm Peripheral disorders of circulation Axis deviations requiring immediate reduction Pre-existing forearm deformities
Rowlands et al.(22) Prospective diagnostic study Single center in Australia November 2011 to May 2012 419/234 Age: 0–16 years History of forearm trauma Suspected fracture Open fracture Imaging performed before arrival

Diagnostic performance of bedside ultrasound in the included studies (n = 7)

Study TP FP TN Sensitivity (95% CI) Specificity (95% CI) PPV (95% CI) NPV (95% CI) LR+ (95% CI) LR-(95% CI) AUC (95% CI) Prevalence % (95% CI) Accuracy % (95% CI)
Patel et al.(21) 34 2 20 1.00 (0.90–1.00) 0.91 (0.71–0.99) 0.94 (0.81–0.99) 1.00 (0.83–1.00) 11.00 (2.93–41.2) 0 0.95 (0.86–0.99) 60.7 (46.8–73.5) 96.4 (87.7–99.6)
Ackermann et al.(16) 72 0 16 0.94 (0.85–0.98) 1.00 (0.79–1.00) 1.00 (0.95–1.00) 0.76 (0.53–0.92) 0.06 (0.03–0.15) 0.97 (0.91–0.99) 82.8 (73.6–89.8) 94.6 (87.9–98.2)
Chaar-Alvarez et al.(18) 40 15 41 0.85 (0.72–0.94) 0.73 (0.60–0.84) 0.72 (0.59–0.84) 0.85 (0.72–0.94) 3.18 (2.03–4.98) 0.20 (0.10–0.41) 0.79 (0.70–0.87) 45.6 (35.8–55.7) 78.6 (69.5–86.1)
Barata et al.(17) 41 8 47 0.95 (0.84–0.99) 0.86 (0.73–0.94) 0.84 (0.70–0.93) 0.96 (0.86–1.00) 6.56 (3.44–12.48) 0.05 (0.01–0.21) 0.90 (0.83–0.95) 43.9 (33.9–54.3) 89.8 (82.0–95.0)
Eckert et al.(19) 50 1 24 0.96 (0.87–1.00) 0.96 (0.80–1.00) 0.98 (0.90–1.00) 0.92 (0.75–0.99) 24.04 (3.52–164.16) 0.04 (0.01–0.16) 0.96 (0.89–0.99) 67.5 (55.9–77.8) 96.1 (89.0–99.2)
Herren et al. 103 0 97 0.99 (0.95–1.00) 1.00 (0.96–1.00) 1.00 (0.97–1.00) 0.99 (0.95–1.00) 0.01 (0.00–0.07) 1.00 (0.97–1.00) 51.7 (44.6–58.8) 99.5 (97.3–100.0)
Rowlands et al.(22) 214 23 162 0.91 (0.87–0.95) 0.88 (0.82–0.92) 0.90 (0.86–0.94) 0.89 (0.84–0.93) 7.36 (5.01–10.80) 0.10 (0.06–0.15) 0.90 (0.86–0.92) 55.9 (51.0–60.7) 89.7 (86.4–92.5)

Risk of bias assessment of the included studies using QUADAS II and STARD criteria (n = 7)

Patel et al.(21) Ackermann et al.(16) Chaar-Alvarez et al.(18) Barata et al.(17) Eckert et al.(19) Herren et al.(20) Rowlands et al.22
QUADAS II criteria
Was the spectrum of patients representative of the patients who will receive the test in practice? yes yes no no unclear yes no
Is the reference standard likely to correctly classify the target condition? yes yes yes yes yes yes yes
Were selection criteria clearly described? yes yes yes yes yes yes yes
Is the time period between reference standard and index test short enough to be reasonably sure that the target condition did not change between the two tests? yes unclear yes yes yes yes yes
Did the whole sample or a random selection of the sample, receive verification using a reference standard of diagnosis? yes yes yes yes unclear unclear yes
Did patients receive the same reference standard regardless of the index test result? yes yes yes yes yes yes yes
Was the execution of the index test described in sufficient detail to permit replication of the test? yes unclear yes yes yes yes unclear
Was the execution of the reference standard described in sufficient detail to permit its replication? yes unclear yes unclear yes yes unclear
Were the index test results interpreted without knowledge of the results of the reference standard? yes unclear yes unclear unclear unclear yes
Were the reference standard results interpreted without knowledge of the results of the index test? yes unclear yes unclear unclear yes yes
Was the reference standard independent of the index test? yes yes yes yes yes yes yes
Were the same clinical data available when test results were interpreted as would be available when the test is used in practice? no unclear no yes yes yes yes
Were uninterpretable/intermediate test results reported? unclear yes unclear yes unclear yes unclear
Were withdrawals from the study explained? unclear yes yes unclear unclear unclear yes
Score 12 11 11.5 11 11 12.5 11.5
STARD criteria
The sampling process is described no no yes yes no unclear yes
Sensitivity and specificity results are presented with their respective confidence intervals yes no yes yes no no no
The demographic characteristics of patients are described no no no yes no yes no
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Basic Medical Science, Basic Medical Science, other
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