Table 4.
Reported clinical decision aids
| Author | Year | Clinical decision aid | Sens. (95% CI) | Spec. (95% CI) | PPV (95% CI) | NPV (95% CI) | LR + (95% CI) | LR- (95% CI) |
|---|---|---|---|---|---|---|---|---|
| Exadaktylos et al. [55] | 2005 | Orbital fracture decision tool for no symptoms | 15.3 (9.9–22.8) | 5.2 (3.5–7.5) | 3.8 (2.4–5.9) | 20.0 (13.9–27.9) | 0.2 (0.1–0.2) | 16.3 (11.1–24.1) |
| Exadaktylos et al. [55] | 2005 | Orbital fracture decision tool for blepharohematoma only | 29.7 (22.2–38.4) | 94.8 (92.5–96.5) | 58.3 (45.7–69.9) | 84.6 (81.3–87.4) | 5.7 (3.6–9.2) | 0.7 (0.7–0.8) |
| Exadaktylos et al. [55] | 2005 | Orbital fracture decision tool for any symptoms | 55.1 (46.1–63.8) | 100.0 (99.2–100.0) | 100.0 (94.4–100.0) | 90.1 (87.3–92.3) | ∞ | 0.4 (0.4–0.5) |
| Sitzman et al. [56] | 2011 | Wisconsin criteria | 98.2 (96.1–99.2) | 22.3 (17.0–28.7) | 68.5 (64.2–72.5) | 87.8 (75.8–94.3) | 1.3 (1.2–1.4) | 0.1 (0.0–0.2) |
| Sitzman et al. [60] | 2015 | Wisconsin criteria | 97.4 (92.7–99.1) | 20.6 (12.5–32.2) | 69.3 (61.9–75.9) | 81.3 (57.0–93.4) | 1.2 (1.1–1.4) | 0.1 (0.0–0.4) |
| Timashpolksy et al. [61] | 2016 | Wisconsin criteria | 89.8 (78.2–95.6) | 40.0 (11.8–76.9) | 93.6 (82.8–97.8) | 28.6 (8.2–64.1) | 1.5 (0.7–3.1) | 0.3 (0.1–1.0) |
| Harrington et al. [64] | 2018 | Wisconsin criteria | 80.8 (72.0–87.4) | 41.2 (30.3–53.0) | 66.7 (57.8–74.5) | 59.6 (45.3–72.4) | 1.4 (1.1–1.7) | 0.5 (0.3–0.8) |
| Yadav et al. [57] | 2012 | Orbital fracture risk score 0 | 88.5 (85.0–92.0) | 32.5 (30.3–34.7) | - | 93.7 (91.8–95.7) | - | 0.4 (0.3–0.5) |
| Orbital fracture risk score 1 | 55.3 (49.7–61.0) | 77.1 (75.0–79.1) | - | 90.1 (88.6–91.6) | - | 0.6 (0.5–0.7) | ||
| Orbital fracture risk score 2 | 25.8 (21.0–30.7) | 93.8 (92.6–94.9) | - | 87.0 (85.5–88.5) | - | 0.8 (0.7–0.8) | ||
| Orbital fracture risk score 3 | 8.2 (5.3–11.2) | 98.9 (98.4–99.4) | - | 85.1 (83.6–86.5) | - | 0.9 (0.9–1.0) | ||
| Orbital fracture risk score 4 | 1.9 (0.2–3.5) | 99.7 (99.5–100.0) | - | 84.3 (82.8–85.8) | - | 1.0 (1.0–1.0) | ||
| Orbital fracture risk score 5–6 | 0.2 (0.0–0.7) | 99.9 (99.7–100.0) | - | 84.1 (82.6–85.6) | - | 1.0 (1.0–1.0) | ||
| Scolozzi et al. [62] | 2017 | Orbital fracture score > 1 | 97.3 (95.8–98.3) | 6.2 (3.6–10.3) | 77.5 (74.6–80.1) | 40.6 (25.5–57.7) | 1.0 (1.0–1.1) | 0.4 (0.2–0.9) |
| Orbital fracture score > 2 | 76.7 (73.5–79.7) | 60.2 (53.5–66.6) | 86.5 (83.6–89.0) | 43.8 (38.2–49.5) | 1.9 (1.6–2.3) | 0.4 (0.3–0.5) | ||
| Orbital fracture score > 3 | 40.1 (36.5–43.8) | 90.5 (85.8–93.8) | 93.4 (90.0–95.7) | 31.3 (27.7–35.0) | 4.2 (2.8–6.5) | 0.7 (0.6–0.7) | ||
| Orbital fracture score > 4 | 14.7 (12.3–17.5) | 97.2 (93.9–98.7) | 94.5 (88.5–97.5) | 25.5 (22.6–28.7) | 5.2 (2.3–11.6) | 0.9 (0.8–0.9) | ||
| Allison et al. [65] | 2019 | Orbital fracture decision tool | 80.0 (64.1–90.0) | 75.0 (46.8–91.1) | 90.3 (75.1–96.7) | 56.3 (33.2–76.9) | 3.2 (1.2–8.6) | 0.3 (0.1–0.6) |
| Timashpolksy et al. [61] | 2016 | SBUH nose | 87.5 (52.9–97.8) | 87.8 (75.8–94.3) | 53.8 (29.1–76.8) | 97.7 (88.2–99.6) | 7.1 (3.2–15.8) | 0.1 (0.0–0.9) |
| SBUH orbital floor | 92.0 (75.0–97.8) | 75.0 (57.9–86.7) | 74.2 (56.8–86.3) | 92.3 (75.9–97.9) | 3.7 (2.0–6.8) | 0.1 (0.0–0.4) | ||
| SBUH zygoma | 88.9 (67.2–96.9) | 51.3 (36.2–66.1) | 45.7 (30.5–61.8) | 90.9 (72.2–97.5) | 1.8 (1.3–2.6) | 0.2 (0.1–0.8) |
Sens. sensitivity; Spec. specificity; PPV positive predictive value; NPV negative predictive value; LR + positive likelihood ratio; LR- negative likelihood ratio; CI confidence interval; SBUH Stony Brook University Hospital
- Orbital fracture decision tool- divided into: ‘no symptoms’, ‘blepharohaematoma only’ or ‘any symptoms’ thereof; blepharohaematoma of one or two orbits, palpable fracture line, infra-orbital nerve hypesthesia, ocular motility disturbance, skin emphysema, enophthalmos or exophthalmos, impaired pupil reaction and decrease in vision
- Wisconsin criteria- the presence of any of the following findings: bony step-off or instability, malocclusion, tooth absence, peri-orbital swelling or contusion, and a Glasgow coma score of less than 14
- Orbital fracture risk score (0–6)- a risk score assigning a point for: orbital rim tenderness, peri-orbital emphysema, subconjunctival hemorrhage, impaired extra-ocular movement, painful extra-ocular movement and epistaxis
- Orbital fracture score (0–4 +)- a risk score assigning a point for: male sex, etiology other than assault, peri-orbital ecchymosis, peri-orbital emphysema, infra-orbital nerve hypoesthesia and diplopia
- Orbital fracture decision tool- the presence of any of the following findings: unbounded subconjunctival hemorrhage, reduced sensation in the distribution of the infra-orbital nerve, change in position of the globe, reduced visual acuity or any two from peri-orbital bruising, diplopia and limited eye movement
- SBUH nose- presence of the any of the following findings: bony or septal deviation, septal hematoma, tenderness, depression/angulation, ecchymosis or swelling
- SBUH orbital floor- the presence of the any of the following findings: subjective diplopia, upgaze limitation, enophthalmos /depression, infra-orbital nerve paresthesia or anaesthesia, subconjunctival hemorrhage, ecchymosis or swelling
- SBUH zygoma- presence of the any of the following findings: cheek flatness, subconjuctival haemorrhage, trismus, antimongoloid slant, infra-orbital nerve paraesthesia/anaesthesia, ecchymosis or swelling and palpable step