Table 1.
Characteristics of the Currently Available Systematic Reviews on the Diagnostic Accuracy of Tests
| Author(s) | Population in eligible studies as described by the review authors | Fracture | Number of studies included | Diagnostic test | Pooled Se (95% CI) |
Pooled Sp (95% CI) |
Positive LR | Conclusion |
|---|---|---|---|---|---|---|---|---|
| HISTORY TAKING | ||||||||
| Carpenter (2014) [32] | Emergency Department. | Scaphoid | 0 | History examination alone is inadequate to rule in or rule out scaphoid fracture. | ||||
| PHYSICAL EXAMINATION | ||||||||
| Carpenter (2014) [32] | Emergency Department. | Scaphoid | 6 | ASB tenderness | 0.96 (0.92–0.98) | 0.39 (0.36–0.43) | Except for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, physical examination alone is inadequate to rule in or rule out scaphoid fracture. | |
| 6 | LTC | 0.82 (0.77–0.87) | 0.58 (0.54–0.62) | |||||
| 7 | Ultrasound fibration pain | 0.67 (0.59–0.75) | 0.57 (0.51–0.62) | |||||
| 3 | Clamp sign | 0.73 (0.67–0.78) | 0.92 (0.89–0.95) | |||||
| 3 | Painfull ulnar deviation | 0.77 (0.68–0.83) | 0.42 (0.34–0.49) | |||||
| 3 | STT | 0.92 (0.86–0.96) | 0.47 (0.43–0.52) | |||||
| 2 | Resisted supination pain | 0.94 (0.85–0.98) | 0.74 (0.63–0.84) | |||||
| Burrows (2014) [33] | Not specified | Scaphoid | 5 | ASB tenderness | 1.52 (1.12–2.06) | Three clinical tests with statistically significant diagnostic validity were identified. In isolation, the clinical significance of each is questionable. | ||
| 7 | Scaphoid compression test | 2.37 (1.27–4.41) | ||||||
| 3 | STT | 1.67 (1.33–2.09) | ||||||
| Mallee (2015) [34] | Patients presenting to the emergency department or outpatient clinic | Scaphoid | 8 | ASB tenderness | 0.87–1.00 a | 0.03–0.98 b | Anatomical snuff box tenderness was the most sensitive clinical test. The low specificity of the clinical tests may result in a considerable number of over-treated patients. Combining tests improved the post-test fracture probability. | |
| 8 | LTC | 0.48–1.00 a | 0.22–0.97 b | |||||
| 4 | STT | 0.82–1.00 a | 0.17–0.57 b | |||||
| 4 | Painfull ulnar deviation | 0.67–1.00 a | 0.17–0.60 b | |||||
| 4 | ASB swelling | 0.67–0.77 a | 0.37–0.72 b | |||||
| IMAGING | ||||||||
| Carpenter (2014) [32] | Emergency Department. | Scaphoid | 5 | X-ray fat pad | 0.82 (0.76–0.86) | 0.72 (0.68–0.75) | MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x-rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures. | |
| 18 | BS | 0.91 (0.87–0.94) | 0.86 (0.83–0.88) | |||||
| 6 | US | 0.80 (0.67–0.90) | 0.87 (0.81–0.91) | |||||
| 8 | CT | 0.83 (0.83–0.89) | 0.97 (0.94–0.98) | |||||
| 13 | MRI | 0.96 (0.92–0.99) | 0.98 (0.96–0.99) | |||||
| Yin (2012) [35] | Not specified | Scaphoid | 28 | Follow-up radiographs | 0.91 (0.81–0.98) | 1.00 (0.99–1.00) | If we acknowledge the lack of a reference standard for diagnosing suspected scaphoid fractures, MRI is the most accurate test; follow-up radiographs and CT may be less sensitive, and bone scintigraphy less specific. | |
| 18 | BS | 0.98 (0.96–0.99) | 0.94 (0.91–0.95) | |||||
| 15 | MRI | 0.98 (0.95–0.99) | 1.00 (0.99–1.00) | |||||
| 9 | CT | 0.85 (0.74–0.94) | 1.00 (0.98–1.00) | |||||
| Yin (2010) [36] | Not specified | Scaphoid | 15 | BS | 0.97 (0.93–0.99) | 0.89 (0.83–0.94) | Bone scintigraphy and MRI have equally high sensitivity and high diagnostic value for excluding scaphoid fracture; however, MRI is more specific and better for confirming scaphoid fracture. | |
| 10 | MRI | 0.96 (0.91–0.99) | 0.99 (0.96–1.00) | |||||
| 6 | CT | 0.93 (0.83–0.98) | 0.99 (0.96–1.00) | |||||
| Mallee (2014) [34] | People of all ages who presented at hospital or clinic | Scaphoid | 6 | BS | 0.99 (0.69–1.00) | 0.86 (0.73–0.94) | Bone scintigraphy is statistically the best diagnostic modality to establish a definitive diagnosis in clinically suspected fractures when radiographs appear normal. The number of overtreated patients is substantially lower with CT and MRI. | |
| 4 | CT | 0.72 (0.36–0.92) | 0.99 (0.71–1.00) | |||||
| 5 | MRI | 0.88 (0.64–0.97) | 1.00 (0.38–1.00) | |||||
| Kwee (2018) [37] | Not specified | Scaphoid | 7 | US | 0.86 (0.74–0.93) | 0.84 (0.72–0.91) | Ultrasound can diagnose radiographically occult scaphoid fracture with a fairly high degree of accuracy. | |
| Ali (2018) [38] | Not specified | Scaphoid | 6 | US | 0.94 (0.78–1.00) | 0.89 (0.78–1.00) | US reveals high sensitivity and specificity in scaphoid fracture diagnosis. | |
ASB Anatomic snuff-box, LTC Longitudinal (thumb) compression test, STT Scaphoid tubercle tenderness, BS Bone Scintigraphy, US Ultrasound, CT Computed TomographyMRI: Magnetic Resonance Imaging
aSensitivity range described, because of the high heterogeneity Mallee et al. [34] refrained from calculating pooled estimate points
bSpecificity Range described, because of the high heterogeneity Mallee et al. [34] refrained from calculating pooled estimate points