Table 3.
Diagnostic accuracy of individual physical examination findings
| Physical examination finding | Authors and reference | Fracture outcome | Sens. (95% CI) | Spec. (95% CI) | Pre-test prob. (95% CI) | PPV (95% CI) | NPV (95% CI) | LR + (95% CI) | LR- (95% CI) |
|---|---|---|---|---|---|---|---|---|---|
| Visual appearance | |||||||||
| Swelling | Sitzman et al. [56] | Midfacial and mandibular fractures | 81.0 (76.5–84.9) | 47.2 (40.2–54.2) | 63.2 (59.0–67.3) | 72.5 (67.8–76.8) | 59.1 (51.2–66.5) | 1.5 (1.3–1.8) | 0.4 (0.3–0.5) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 58.6 (49.5–67.2) | 74.6 (62.7–83.7) | 64.8 (57.6–71.4) | 81.0 (71.3–87.9) | 49.5 (39.6–59.4) | 2.3 (1.5–3.6) | 0.6 (0.4–0.7) | |
| Swelling or hematoma | Timashpolsky et al. [61] | Orbital floor fractures | 64.0 (44.5–79.8) | 81.3 (64.7–91.1) | 43.9 (31.8–56.7) | 72.7 (51.8–86.8) | 74.3 (57.9–85.8) | 3.4 (1.6–7.4) | 0.4 (0.3–0.8) |
| Timashpolsky et al. [61] | Zygoma fractures | 16.7 (5.8–39.2) | 84.6 (70.3–92.8) | 31.6 (21.0–44.5) | 33.3 (12.1–64.6) | 68.8 (54.7–80.1) | 1.1 (0.3–3.9) | 1.0 (0.8–1.3) | |
| Swelling, peri-orbital | Yadav et al. [57] | Orbital fractures | 78.3 (73.8–82.3) | 43.7 (41.5–46.0) | 15.9 (14.5–17.5) | 20.9 (18.8–23.1) | 91.4 (89.4–93.1) | 1.4 (1.3–1.5) | 0.5 (0.4–0.6) |
| Swelling or hematoma, peri-orbital | Harrington et al. [64] | Midfacial and mandibular fractures | 47.5 (37.9–57.2) | 63.2 (51.4–73.7) | 59.3 (51.7–66.4) | 65.3 (53.8–75.2) | 45.3 (35.6–55.3) | 1.3 (0.9–1.9) | 0.8 (0.6–1.1) |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 92.5 (88.7–95.1) | 35.5 (29.9–41.5) | 50.7 (46.4–54.9) | 59.6 (54.8–64.2) | 82.1 (74.0–88.1) | 1.4 (1.3–1.6) | 0.2 (0.1–0.3) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 82.8 (74.9–88.6) | 34.9 (24.3–47.2) | 64.8 (57.6–71.4) | 70.1 (61.9–77.1) | 52.4 (37.7–66.6) | 1.3 (1.0–1.6) | 0.5 (0.3–0.8) | |
| Hematoma | Sitzman et al. [56] | Midfacial and mandibular fractures | 87.3 (83.3–90.5) | 17.1 (12.4–23.0) | 63.2 (59.0–67.3) | 64.4 (59.9–68.7) | 44.0 (33.3–55.3) | 1.1 (1.0–1.1) | 0.7 (0.5–1.1) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 89.7 (82.8–94.0) | 22.2 (13.7–33.9) | 64.8 (57.6–71.4) | 68.0 (60.2–74.8) | 53.8 (35.5–71.2) | 1.2 (1.0–1.3) | 0.5 (0.2–0.9) | |
| Hematoma, forehead | Sitzman et al. [56] | Midfacial and mandibular fractures | 28.0 (23.5–33.1) | 67.4 (60.5–73.6) | 63.2 (59.0–67.3) | 59.6 (51.8–67.0) | 35.2 (30.5–40.2) | 0.9 (0.7–1.1) | 1.1 (0.9–1.2) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 28.4 (21.0–37.2) | 82.5 (71.4–90.0) | 64.8 (57.6–71.4) | 75.0 (60.6–85.4) | 38.5 (30.7–46.9) | 1.6 (0.9–3.0) | 0.9 (0.7–1.0) | |
| Hematoma, peri-orbital | Allison et al. [65] | Orbital fractures | 74.3 (57.9–85.8) | 41.7 (19.3–68.0) | 74.5 (60.5–84.7) | 78.8 (62.2–89.3) | 35.7 (16.3–61.2) | 1.3 (0.8–2.1) | 0.6 (0.3–1.5) |
| Holmgren et al. [54] | Midfacial and mandibular fractures | 29.4 (25.4–33.6) | 85.3 (80.9–88.9) | 61.4 (57.9–64.7) | 76.1 (69.4–81.7) | 43.2 (39.2–47.2) | 2.0 (1.5–2.7) | 0.8 (0.8–0.9) | |
| Scolozzi et al. [62] | Orbital fractures | 95.9 (94.1–97.1) | 5.2 (2.9–9.1) | 76.9 (74.0–79.5) | 77.1 (74.2–79.7) | 27.5 (16.1–42.8) | 1.0 (1.0–1.0) | 0.8 (0.4–1.6) | |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 74.1 (69.1–78.5) | 43.0 (36.2–50.1) | 63.2 (59.0–67.3) | 69.1 (64.1–73.7) | 49.1 (41.7–56.6) | 1.3 (1.1–1.5) | 0.6 (0.5–0.8) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 77.6 (69.2–84.2) | 41.3 (30.0–53.6) | 64.8 (57.6–71.4) | 70.9 (62.4–78.1) | 50.0 (36.9–63.1) | 1.3 (1.1–1.7) | 0.5 (0.3–0.9) | |
| Smith et al. [58] | Midfacial fractures | 38.6 (28.8–49.3) | 95.2 (88.3–98.1) | 50.0 (42.5–57.5) | 88.9 (74.7–95.6) | 60.8 (52.2–68.7) | 8.0 (3.0–21.6) | 0.6 (0.5–0.8) | |
| Yadav et al. [57] | Orbital fractures | 75.3 (70.6–79.5) | 47.5 (45.2–49.7) | 15.9 (14.5–17.5) | 21.3 (19.2–23.7) | 91.0 (89.1–92.7) | 1.4 (1.3–1.5) | 0.5 (0.4–0.6) | |
| Hematoma, eyelid | Holmgren et al. [54] | Midfacial and mandibular fractures | 2.7 (1.6–4.6) | 98.7 (96.6–99.5) | 61.4 (57.9–64.7) | 76.5 (52.7–90.4) | 38.9 (35.5–42.5) | 2.0 (0.7–6.2) | 1.0 (1.0–1.0) |
| Exadaktylos et al. [55] | Orbital fractures | 68.6 (59.8–76.3) | 94.8 (92.5–96.5) | 19.7 (16.7–23.0) | 76.4 (67.5–83.5) | 92.5 (89.8–94.5) | 13.2 (8.9–19.8) | 0.3 (0.3–0.4) | |
| Hematoma, nasal | Sitzman et al. [56] | Midfacial and mandibular fractures | 24.1 (19.8–29.0) | 78.2 (71.9–83.5) | 63.2 (59.0–67.3) | 65.6 (56.8–73.4) | 37.5 (32.9–42.3) | 1.1 (0.8–1.5) | 1.0 (0.9–1.1) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 20.7 (14.3–28.9) | 79.4 (67.8–87.5) | 64.8 (57.6–71.4) | 64.9 (48.8–78.2) | 35.2 (27.8–43.4) | 1.0 (0.5–1.8) | 1.0 (0.9–1.2) | |
| Hematoma, malar | Sitzman et al. [56] | Midfacial and mandibular fractures | 34.0 (29.1–39.3) | 69.4 (62.6–75.5) | 63.2 (59.0–67.3) | 65.7 (58.3–72.4) | 38.0 (33.1–43.1) | 1.1 (0.9–1.4) | 1.0 (0.8–1.1) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 21.6 (15.0–29.9) | 85.7 (75.0–92.3) | 64.8 (57.6–71.4) | 73.5 (56.9–85.4) | 37.2 (29.8–45.3) | 1.5 (0.8–3.0) | 0.9 (0.8–1.1) | |
| Hematoma, facial or scalp | Holmgren et al. [54] | Midfacial and mandibular fractures | 24.9 (21.3–29.0) | 47.3 (41.8–53.0) | 61.4 (57.9–64.7) | 43.0 (37.3–48.8) | 28.4 (24.6–32.5) | 0.5 (0.4–0.6) | 1.6 (1.4–1.8) |
| Laceration | Harrington et al. [64] | Midfacial and mandibular fractures | 42.4 (33.2–52.3) | 57.4 (45.5–68.4) | 59.3 (51.7–66.4) | 59.2 (47.5–69.8) | 40.6 (31.3–50.6) | 1.0 (0.7–1.4) | 1.0 (0.8–1.3) |
| Huang et al. [63] | Midfacial and mandibular fractures | 98.0 (95.0–99.2) | 70.0 (67.6–72.3) | 12.1 (10.6–13.8) | 31.1 (27.6–34.8) | 99.6 (99.0–99.8) | 3.3 (3.0–3.5) | 0.0 (0.0–0.1) | |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 69.3 (64.1–74.0) | 40.9 (34.2–48.0) | 63.2 (59.0–67.3) | 66.9 (61.7–71.6) | 43.6 (36.6–50.9) | 1.2 (1.0–1.3) | 0.8 (0.6–0.9) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 70.7 (61.8–78.2) | 30.2 (20.2–42.4) | 64.8 (57.6–71.4) | 65.1 (56.4–72.8) | 35.8 (24.3–49.3) | 1.0 (0.8–1.2) | 1.0 (0.6–1.6) | |
| Laceration, forehead | Huang et al. [63] | Midfacial and mandibular fractures | 28.0 (22.2–34.6) | 85.5 (83.6–87.2) | 12.1 (10.6–13.8) | 21.1 (16.6–26.3) | 89.6 (87.9–91.1) | 1.9 (1.5–2.5) | 0.8 (0.8–0.9) |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 25.6 (21.2–30.6) | 71.5 (64.8–77.4) | 63.2 (59.0–67.3) | 60.7 (52.4–68.4) | 35.8 (31.2–40.8) | 0.9 (0.7–1.2) | 1.0 (0.9–1.2) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 20.7 (14.3–28.9) | 69.8 (57.6–79.8) | 64.8 (57.6–71.4) | 55.8 (41.1–69.6) | 32.4 (25.1–40.6) | 0.7 (0.4–1.2) | 1.1 (0.9–1.4) | |
| Smith et el. [58] | Midfacial fractures | 22.9 (15.2–33.0) | 90.4 (82.1–95.0) | 50.0 (42.5–57.5) | 70.4 (51.5–84.1) | 54.0 (45.7–62.0) | 2.4 (1.1–5.1) | 0.9 (0.7–1.0) | |
| Laceration, peri-orbital | Sitzman et al. [56] | Midfacial and mandibular fractures | 23.8 (19.5–28.7) | 79.8 (73.6–84.9) | 63.2 (59.0–67.3) | 66.9 (58.0–74.8) | 37.8 (33.3–42.6) | 1.2 (0.8–1.7) | 1.0 (0.9–1.0) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 28.4 (21.0–37.2) | 71.4 (59.3–81.1) | 64.8 (57.6–71.4) | 64.7 (51.0–76.4) | 35.2 (27.4–43.8) | 1.0 (0.6–1.6) | 1.0 (0.8–1.2) | |
| Yadav et al. [57] | Orbital fractures | 32.8 (28.1–37.8) | 77.4 (75.5–79.3) | 15.9 (14.5–17.5) | 21.6 (18.3–25.2) | 85.9 (84.2–87.5) | 1.5 (1.2–1.7) | 0.9 (0.8–0.9) | |
| Laceration, eyebrow | Holmgren et al. [54] | Midfacial and mandibular fractures | 9.9 (7.5–12.9) | 90.0 (86.1–92.9) | 61.4 (57.9–64.7) | 61.0 (49.9–71.2) | 38.6 (35.0–42.2) | 1.0 (0.6–1.5) | 1.0 (1.0–1.1) |
| Laceration, eyelid | Holmgren et al. [54] | Midfacial and mandibular fractures | 13.2 (10.5–16.5) | 87.0 (82.7–90.3) | 61.4 (57.9–64.7) | 61.8 (52.1–70.6) | 38.7 (35.1–42.4) | 1.0 (0.7–1.5) | 1.0 (0.9–1.1) |
| Laceration, conjunctival | Holmgren et al. [54] | Midfacial and mandibular fractures | 0.6 (0.2–1.8) | 99.0 (97.1–99.7) | 61.4 (57.9–64.7) | 50.0 (18.8–81.2) | 38.5 (35.2–42.0) | 0.6 (0.1–3.1) | 1.0 (1.0–1.0) |
| Laceration, nasal | Sitzman et al. [56] | Midfacial and mandibular fractures | 7.2 (4.9–10.5) | 89.1 (83.9–92.8) | 63.2 (59.0–67.3) | 53.3 (39.1–67.1) | 35.8 (31.7–40.2) | 0.7 (0.4–1.2) | 1.0 (1.0–1.1) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 11.2 (6.7–18.2) | 87.3 (76.9–93.4) | 64.8 (57.6–71.4) | 61.9 (40.9–79.2) | 34.8 (27.8–42.5) | 0.9 (0.4–2.0) | 1.0 (0.9–1.1) | |
| Holmgren et al. [54] | Midfacial and mandibular fractures | 21.0 (17.6–24.8) | 91.3 (87.6–94.0) | 61.4 (57.9–64.7) | 79.4 (71.5–85.5) | 42.1 (38.4–45.9) | 2.4 (1.6–3.6) | 0.9 (0.8–0.9) | |
| Laceration, malar | Sitzman et al. [56] | Midfacial and mandibular fractures | 13.3 (10.0–17.3) | 88.6 (83.3–92.4) | 63.2 (59.0–67.3) | 66.7 (54.7–76.8) | 37.3 (33.0–41.8) | 1.2 (0.7–1.9) | 1.0 (0.9–1.0) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 5.2 (2.4–10.8) | 92.1 (82.7–96.6) | 64.8 (57.6–71.4) | 54.5 (28.0–78.7) | 34.5 (27.8–42.0) | 0.7 (0.2–2.1) | 1.0 (0.9–1.1) | |
| Laceration, peri-oral | Sitzman et al. [56] | Midfacial and mandibular fractures | 18.1 (14.3–22.6) | 88.1 (82.8–91.9) | 63.2 (59.0–67.3) | 72.3 (61.8–80.8) | 38.5 (34.0–43.1) | 1.5 (1.0–2.4) | 0.9 (0.9–1.0) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 12.9 (8.0–20.2) | 87.3 (76.9–93.4) | 64.8 (57.6–71.4) | 65.2 (44.9–81.2) | 35.3 (28.2–43.0) | 1.0 (0.5–2.3) | 1.0 (0.9–1.1) | |
| Laceration, lip | Holmgren et al. [54] | Midfacial and mandibular fractures | 26.2 (22.5–30.3) | 85.3 (80.9–88.9) | 61.4 (57.9–64.7) | 74.0 (66.9–80.0) | 42.1 (38.2–46.1) | 1.8 (1.3–2.4) | 0.9 (0.8–0.9) |
| Asymmetry | Sitzman et al. [56] | Midfacial and mandibular fractures | 6.9 (4.7–10.2) | 99.0 (96.3–99.7) | 63.2 (59.0–67.3) | 92.0 (75.0–97.8) | 38.2 (34.0–42.5) | 6.7 (1.6–28.0) | 0.9 (0.9–1.0) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 6.0 (3.0–11.9) | 95.2 (86.9–98.4) | 64.8 (57.6–71.4) | 70.0 (39.7–89.2) | 35.5 (28.7–43.0) | 1.3 (0.3–4.7) | 1.0 (0.9–1.1) | |
| Globe position change | Allison et al. [65] | Orbital fractures | 17.1 (8.1–32.7) | 100.0 (75.7–100.0) | 74.5 (60.5–84.7) | 100.0 (61.0–100.0) | 29.3 (17.6–44.5) | ∞ | 0.8 (0.7–1.0) |
| Malar eminence flattening | Timashpolsky et al. [61] | Zygoma fractures | 72.2 (49.1–87.5) | 94.9 (83.1–98.6) | 31.6 (21.0–44.5) | 86.7 (62.1–96.3) | 88.1 (75.0–94.8) | 14.1 (3.5–56.0) | 0.3 (0.1–0.6) |
| Nasal assessment | |||||||||
| Epistaxis | Büttner et al. [59] | Midfacial and mandibular fractures | 15.6 (13.6–17.8) | 95.5 (93.4–96.9) | 68.3 (66.0–70.4) | 88.1 (82.9–91.9) | 34.5 (32.1–36.9) | 3.4 (2.3–5.2) | 0.9 (0.9–0.9) |
| Huang et al. [63] | Midfacial and mandibular fractures | 25.0 (19.5–31.4) | 99.3 (98.7–99.6) | 12.1 (10.6–13.8) | 83.3 (72.0–90.7) | 90.6 (89.0–91.9) | 36.2 (18.7–70.3) | 0.8 (0.7–0.8) | |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 31.9 (27.1–37.1) | 87.6 (82.2–91.5) | 63.2 (59.0–67.3) | 81.5 (74.0–87.3) | 42.8 (38.0–47.7) | 2.6 (1.7–3.9) | 0.8 (0.7–0.9) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 29.3 (21.8–38.2) | 77.8 (66.1–86.3) | 64.8 (57.6–71.4) | 70.8 (56.8–81.8) | 37.4 (29.6–45.9) | 1.3 (0.8–2.3) | 0.9 (0.8–1.1) | |
| Smith et el. [58] | Midfacial fractures | 22.9 (15.2–33.0) | 96.4 (89.9–98.8) | 50.0 (42.5–57.5) | 86.4 (66.7–95.3) | 55.6 (47.4–63.4) | 6.3 (1.9–20.6) | 0.8 (0.7–0.9) | |
| Yadav et al. [57] | Orbital fractures | 22.5 (18.5–27.1) | 86.5 (84.9–88.0) | 15.9 (14.5–17.5) | 24.0 (19.7–28.8) | 85.5 (83.9–87.0) | 1.7 (1.3–2.1) | 0.9 (0.8–0.9) | |
| Ocular assessment | |||||||||
| Subconjunctival hemorrhage | Allison et al. [65] | Orbital fractures | 45.7 (30.5–61.8) | 91.7 (64.6–98.5) | 74.5 (60.5–84.7) | 94.1 (73.0–99.0) | 36.7 (21.9–54.5) | 5.5 (0.8–37.1) | 0.6 (0.4–0.8) |
| Büttner et al. [59] | Midfacial and mandibular fractures | 16.3 (14.3–18.6) | 90.4 (87.6–92.6) | 68.3 (66.0–70.4) | 78.6 (72.9–83.3) | 33.4 (31.1–35.9) | 1.7 (1.3–2.3) | 0.9 (0.9–1.0) | |
| Holmgren et al. [54] | Midfacial and mandibular fractures | 8.8 (6.6–11.7) | 96.0 (93.1–97.7) | 61.4 (57.9–64.7) | 77.8 (65.1–86.8) | 39.8 (36.3–43.4) | 2.2 (1.2–4.1) | 0.9 (0.9–1.0) | |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 31.3 (26.6–36.5) | 86.5 (81.0–90.6) | 63.2 (59.0–67.3) | 80.0 (72.3–86.0) | 42.3 (37.5–47.2) | 2.3 (1.6–3.4) | 0.8 (0.7–0.9) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 33.6 (25.7–42.6) | 88.9 (78.8–94.5) | 64.8 (57.6–71.4) | 84.8 (71.8–92.4) | 42.1 (34.1–50.6) | 3.0 (1.4–6.4) | 0.7 (0.6–0.9) | |
| Timashpolsky et al. [61] | Orbital floor fractures | 76.0 (56.6–88.5) | 90.6 (75.8–96.8) | 43.9 (31.8–56.7) | 86.4 (66.7–95.3) | 82.9 (67.3–91.9) | 8.1 (2.7–24.3) | 0.3 (0.1–0.5) | |
| Timashpolsky et al. [61] | Zygoma fractures | 55.6 (33.7–75.4) | 69.2 (53.6–81.4) | 31.6 (21.0–44.5) | 45.5 (26.9–65.3) | 77.1 (61.0–87.9) | 1.8 (1.0–3.4) | 0.6 (0.4–1.1) | |
| Yadav et al. [57] | Orbital fractures | 31.4 (26.8–36.4) | 87.3 (85.8–88.7) | 15.9 (14.5–17.5) | 31.9 (27.3–36.9) | 87.1 (85.5–88.5) | 2.5 (2.0–3.0) | 0.8 (0.7–0.8) | |
| Hyphema | Yadav et al. [57] | Orbital fractures | 4.7 (3.0–7.4) | 97.6 (96.8–98.2) | 15.9 (14.5–17.5) | 27.0 (17.6–39.0) | 84.4 (82.8–85.9) | 2.0 (1.1–3.4) | 1.0 (1.0–1.0) |
| Diplopia | Allison et al. [65] | Orbital fractures | 42.9 (28.0–59.1) | 83.3 (55.2–95.3) | 74.5 (60.5–84.7) | 88.2 (65.7–96.7) | 33.3 (19.2–51.2) | 2.6 (0.7–9.6) | 0.7 (0.5–1.0) |
| Büttner et al. [59] | Midfacial and mandibular fractures | 15.0 (13.1–17.2) | 98.3 (96.8–99.1) | 68.3 (66.0–70.4) | 95.0 (90.8–97.4) | 35.0 (32.6–37.4) | 8.9 (4.6–17.2) | 0.9 (0.8–0.9) | |
| Scolozzi et al. [62] | Orbital fractures | 39.9 (36.4–43.6) | 84.8 (79.4–89.0) | 76.9 (74.0–79.5) | 89.7 (85.9–92.6) | 29.8 (26.3–33.6) | 2.6 (1.9–3.7) | 0.7 (0.7–0.8) | |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 7.2 (4.9–10.5) | 95.9 (92.0–97.9) | 63.2 (59.0–67.3) | 75.0 (57.9–86.7) | 37.5 (33.4–41.9) | 1.7 (0.8–3.8) | 1.0 (0.9–1.0) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 4.3 (1.9–9.7) | 100.0 (94.3–100.0) | 64.8 (57.6–71.4) | 100.0 (56.6–100.0) | 36.2 (29.4–43.6) | ∞ | 1.0 (0.9–1.0) | |
| Yadav et al. [57] | Orbital fractures | 3.3 (1.9–5.7) | 98.5 (97.8–98.9) | 15.9 (14.5–17.5) | 29.3 (17.6–44.5) | 84.3 (82.8–85.8) | 2.2 (1.1–4.2) | 1.0 (1.0–1.0) | |
| Extra-ocular movement limitation | Allison et al. [65] | Orbital fractures | 25.7 (14.2–42.1) | 83.3 (55.2–95.3) | 74.5 (60.5–84.7) | 81.8 (52.3–94.9) | 27.8 (15.8–44.0) | 1.5 (0.4–6.2) | 0.9 (0.6–1.2) |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 14.2 (10.8–18.3) | 96.4 (92.7–98.2) | 63.2 (59.0–67.3) | 87.0 (75.6–93.6) | 39.5 (35.2–44.0) | 3.9 (1.8–8.5) | 0.9 (0.8–0.9) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 12.1 (7.3–19.2) | 98.4 (91.5–99.7) | 64.8 (57.6–71.4) | 93.3 (70.2–98.8) | 37.8 (30.7–45.4) | 7.6 (1.0–56.5) | 0.9 (0.8–1.0) | |
| Yadav et al. [57] | Orbital fractures | 11.7 (8.7–15.4) | 95.9 (94.9–96.7) | 15.9 (14.5–17.5) | 35.0 (27.1–43.9) | 85.2 (83.6–86.6) | 2.8 (2.0–4.1) | 0.9 (0.9–1.0) | |
| Extra-ocular movement pain | Yadav et al. [57] | Orbital fractures | 21.4 (17.5–25.9) | 92.1 (90.8–93.2) | 15.9 (14.5–17.5) | 33.9 (28.1–40.3) | 86.1 (84.5–87.5) | 2.7 (2.1–3.5) | 0.9 (0.8–0.9) |
| Visual acuity change | Allison et al. [65] | Orbital fractures | 20.0 (10.0–35.9) | 100.0 (75.7–100.0) | 74.5 (60.5–84.7) | 100.0 (64.6–100.0) | 30.0 (18.1–45.4) | ∞ | 0.8 (0.7–0.9) |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 9.9 (7.2–13.6) | 93.8 (89.4–96.4) | 63.2 (59.0–67.3) | 73.3 (59.0–84.0) | 37.7 (33.5–42.1) | 1.6 (0.8–3.0) | 1.0 (0.9–1.0) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 7.8 (4.1–14.1) | 96.8 (89.1–99.1) | 64.8 (57.6–71.4) | 81.8 (52.3–94.9) | 36.3 (29.4–43.8) | 2.4 (0.5–11.0) | 1.0 (0.9–1.0) | |
| Intra-oral assessment | |||||||||
| Laceration, intra-oral | Holmgren et al. [54] | Midfacial and mandibular fractures | 28.5 (24.6–32.7) | 90.3 (86.5–93.2) | 61.4 (57.9–64.7) | 82.4 (75.9–87.5) | 44.3 (40.4–48.2) | 2.9 (2.0–4.3) | 0.8 (0.7–0.8) |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 17.2 (13.5–21.6) | 92.7 (88.2–95.6) | 63.2 (59.0–67.3) | 80.3 (69.6–87.9) | 39.4 (35.0–44.0) | 2.4 (1.4–4.1) | 0.9 (0.8–1.0) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 19.0 (12.9–27.0) | 95.2 (86.9–98.4) | 64.8 (57.6–71.4) | 88.0 (70.0–95.8) | 39.0 (31.6–46.8) | 4.0 (1.2–12.8) | 0.9 (0.8–0.9) | |
| Tooth avulsion | Harrington et al. [64] | Midfacial and mandibular fractures | 11.1 (6.3–18.8) | 100.0 (94.7–100.0) | 59.3 (51.7–66.4) | 100.0 (74.1–100.0) | 43.6 (36.1–51.4) | ∞ | 0.9 (0.8–1.0) |
| Huang et al. [63] | Midfacial and mandibular fractures | 4.5 (2.4–8.3) | 99.2 (98.6–99.5) | 12.1 (10.6–13.8) | 42.9 (24.5–63.5) | 88.3 (86.6–89.7) | 5.4 (2.3–12.7) | 1.0 (0.9–1.0) | |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 16.6 (13.0–20.9) | 97.9 (94.8–99.2) | 63.2 (59.0–67.3) | 93.2 (83.8–97.3) | 40.6 (36.2–45.1) | 8.0 (2.9–21.7) | 0.9 (0.8–0.9) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 11.2 (6.7–18.2) | 96.8 (89.1–99.1) | 64.8 (57.6–71.4) | 86.7 (62.1–96.3) | 37.2 (30.2–44.8) | 3.5 (0.8–15.2) | 0.9 (0.8–1.0) | |
| Malocclusion | Harrington et al. [64] | Midfacial and mandibular fractures | 8.1 (4.2–15.1) | 100.0 (94.7–100.0) | 59.3 (51.7–66.4) | 100.0 (67.6–100.0) | 42.8 (35.3–50.5) | ∞ | 0.9 (0.9–1.0) |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 26.2 (21.8–31.2) | 92.7 (88.2–95.6) | 63.2 (59.0–67.3) | 86.1 (78.1–91.6) | 42.2 (37.6–47.0) | 3.6 (2.1–6.2) | 0.8 (0.7–0.9) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 19.0 (12.9–27.0) | 95.2 (86.9–98.4) | 64.8 (57.6–71.4) | 88.0 (70.0–95.8) | 39.0 (31.6–46.8) | 4.0 (1.2–12.8) | 0.9 (0.8–0.9) | |
| Functional and palpation assessment | |||||||||
| Facial pain | Sitzman et al. [56] | Midfacial and mandibular fractures | 35.2 (30.3–40.5) | 68.9 (62.1–75.0) | 63.2 (59.0–67.3) | 66.1 (58.9–72.7) | 38.2 (33.3–43.4) | 1.1 (0.9–1.5) | 0.9 (0.8–1.1) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 44.8 (36.1–53.9) | 69.8 (57.6–79.8) | 64.8 (57.6–71.4) | 73.2 (61.9–82.1) | 40.7 (31.9–50.2) | 1.5 (1.0–2.3) | 0.8 (0.6–1.0) | |
| Infra-orbital nerve paresthesia | Allison et al. [65] | Orbital fractures | 25.7 (14.2–42.1) | 91.7 (64.6–98.5) | 74.5 (60.5–84.7) | 90.0 (59.6–98.2) | 29.7 (17.5–45.8) | 3.1 (0.4–21.9) | 0.8 (0.6–1.1) |
| Büttner et al. [59] | Midfacial and mandibular fractures | 22.2 (19.9–24.7) | 96.4 (94.5–97.7) | 68.3 (66.0–70.4) | 93.0 (89.4–95.5) | 36.6 (34.1–39.1) | 6.2 (3.9–9.8) | 0.8 (0.8–0.8) | |
| Scolozzi et al. [62] | Orbital fractures | 31.1 (27.8–34.6) | 91.0 (86.4–94.2) | 76.9 (74.0–79.5) | 92.0 (87.8–94.8) | 28.4 (25.2–32.0) | 3.5 (2.2–5.4) | 0.8 (0.7–0.8) | |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 0.3 (0.1–1.7) | 100.0 (98.0–100.0) | 63.2 (59.0–67.3) | 100.0 (20.7–100.0) | 36.8 (32.8–41.0) | ∞ | 1.0 (1.0–1.0) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 5.2 (2.4–10.8) | 98.4 (91.5–99.7) | 64.8 (57.6–71.4) | 85.7 (48.7–97.4) | 36.0 (29.2–43.5) | 3.3 (0.4–26.5) | 1.0 (0.9–1.0) | |
| Timashpolsky et al. [61] | Orbital floor fractures | 36.0 (20.2–55.5) | 90.6 (75.8–96.8) | 43.9 (31.8–56.7) | 75.0 (46.8–91.1) | 64.4 (49.8–76.8) | 3.8 (1.2–12.7) | 0.7 (0.5–1.0) | |
| Timashpolsky et al. [61] | Zygoma fractures | 38.9 (20.3–61.4) | 87.2 (73.3–94.4) | 31.6 (21.0–44.5) | 58.3 (32.0–80.7) | 75.6 (61.3–85.8) | 3.0 (1.1–8.3) | 0.7 (0.5–1.0) | |
| Yadav et al. [57] | Orbital fractures | 5.6 (3.6–8.4) | 97.5 (96.7–98.1) | 15.9 (14.5–17.5) | 29.9 (20.2–41.7) | 84.5 (82.9–86.0) | 2.2 (1.3–3.7) | 1.0 (0.9–1.0) | |
| Subcutaneous emphysema | Büttner et al. [59] | Midfacial and mandibular fractures | 10.7 (9.0–12.6) | 99.6 (98.6–99.9) | 68.3 (66.0–70.4) | 98.4 (94.3–99.6) | 34.1 (31.8–36.5) | 28.4 (7.0–114.3) | 0.9 (0.9–0.9) |
| Scolozzi et al. [62] | Orbital fractures | 25.4 (22.3–28.7) | 94.8 (90.9–97.1) | 76.9 (74.0–79.5) | 94.2 (89.9–96.7) | 27.7 (24.5–31.0) | 4.9 (2.7–8.8) | 0.8 (0.7–0.8) | |
| Tenderness on palpation | Timashpolsky et al. [61] | Nasal bone fracture | 87.5 (52.9–97.8) | 89.8 (78.2–95.6) | 14.0 (7.3–25.3) | 58.3 (32.0–80.7) | 97.8 (88.4–99.6) | 8.6 (3.6–20.5) | 0.1 (0.0–0.9) |
| Yadav et al. [57] | Orbital fractures | 72.8 (68.0–77.1) | 48.7 (46.5–51.0) | 15.9 (14.5–17.5) | 21.2 (19.0–23.5) | 90.4 (88.5–92.1) | 1.4 (1.3–1.5) | 0.6 (0.5–0.7) | |
| Palpable step-off | Büttner et al. [59] | Midfacial and mandibular fractures | 18.5 (16.4–20.9) | 99.8 (98.9–100.0) | 68.3 (66.0–70.4) | 99.5 (97.4–99.9) | 36.3 (33.9–38.8) | 98.6 (13.9–701.3) | 0.8 (0.8–0.8) |
| Harrington et al. [64] | Midfacial and mandibular fractures | 5.1 (2.2–11.3) | 100.0 (94.7–100.0) | 59.3 (51.7–66.4) | 100.0 (56.6–100.0) | 42.0 (34.6–49.7) | ∞ | 0.9 (0.9–1.0) | |
| Sitzman et al. [56] | Midfacial and mandibular fractures | 41.9 (36.7–47.2) | 89.6 (84.5–93.2) | 63.2 (59.0–67.3) | 87.4 (81.4–91.7) | 47.3 (42.2–52.4) | 4.0 (2.6–6.2) | 0.6 (0.6–0.7) | |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 32.8 (24.9–41.7) | 93.7 (84.8–97.5) | 64.8 (57.6–71.4) | 90.5 (77.9–96.2) | 43.1 (35.1–51.4) | 5.2 (1.9–13.8) | 0.7 (0.6–0.8) | |
| Yadav et al. [57] | Orbital fractures | 7.8 (5.4–11.0) | 94.7 (93.6–95.7) | 15.9 (14.5–17.5) | 21.9 (15.6–29.8) | 84.4 (82.8–85.9) | 1.5 (1.0–2.2) | 1.0 (0.9–1.0) | |
| Trismus | Timashpolsky et al. [61] | Zygoma fractures | 38.9 (20.3–61.4) | 94.9 (83.1–98.6) | 31.6 (21.0–44.5) | 77.8 (45.3–93.7) | 77.1 (63.5–86.7) | 7.6 (1.7–32.9) | 0.6 (0.4–0.9) |
| Yadav et al. [57] | Orbital fractures | 3.6 (2.1–6.1) | 95.5 (94.5–96.4) | 15.9 (14.5–17.5) | 13.3 (7.9–21.4) | 84.0 (82.4–85.5) | 0.8 (0.5–1.4) | 1.0 (1.0–1.0) | |
| Mandible locked open | Yadav et al. [57] | Orbital fractures | 0.8 (0.3–2.4) | 98.6 (97.9–99.0) | 15.9 (14.5–17.5) | 10.0 (3.5–25.6) | 84.0 (82.4–85.5) | 0.6 (0.2–1.9) | 1.0 (1.0–1.0) |
| Open fracture | Sitzman et al. [56] | Midfacial and mandibular fractures | 6.3 (4.2–9.5) | 98.4 (95.5–99.5) | 63.2 (59.0–67.3) | 87.5 (69.0–95.7) | 37.9 (33.8–42.2) | 4.1 (1.2–13.5) | 1.0 (0.9–1.0) |
| Sitzman et al. [60] | Midfacial and mandibular fractures | 6.9 (3.5–13.0) | 100.0 (94.3–100.0) | 64.8 (57.6–71.4) | 100.0 (67.6–100.0) | 36.8 (30.0–44.3) | ∞ | 0.9 (0.9–1.0) |
Sens. sensitivity; Spec. specificity; Pre-test prob. pre-test probability; PPV positive predictive value; NPV negative predictive value; LR + positive likelihood ratio; LR- negative likelihood ratio; CI confidence interval; ∞ infinite