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Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis

Mahmoud Yousefifard, Masoud Baikpour, Parisa Ghelichkhani, Hadi Asady, Abolfazl Darafarin, Mohammad Reza Amini Esfahani, Mostafa Hosseini, Mehdi Yaseri, Saeed Safari

Abstract

Introduction: The potential benefit of ultrasonography for detection of thoracic bone fractures has been proven in various surveys but no comprehensive conclusion has been drawn yet; therefore, the present study aimed to conduct a thorough meta-analytic systematic review on this subject. Methods: Two reviewers independently carried out a comprehensive systematic search in Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest databases. Data were summarized as true positive, false positive, true negative and false negative and were analyzed via STATA 11.0 software using a mixed-effects binary regression model. Sources of heterogeneity were further assessed through subgroup analysis. Results: Data on 1667 patients (807 subjects with and 860 cases without thoracic fractures), whose age ranged from 0 to 92 years, were extracted from 17 surveys. Pooled sensitivity and specificity of ultrasonography in detection of thoracic bone fractures were 0.97 (95% CI: 0.90-0.99; I2= 88.88, p<0.001) and 0.94 (95% CI: 0.86-0.97; I2= 71.97, p<0.001), respectively. The same measures for chest radiography were found to be 0.77 (95% CI: 0.56-0.90; I2= 97.76, p<0.001) and 1.0 (95% CI: 0.91-1.00; I2= 97.24, p<0.001), respectively. The sensitivity of ultrasonography was higher in detection of rib fractures, compared to fractures of sternum or clavicle (97% vs. 91%). Moreover, the sensitivity was found to be higher when the procedure was carried out by a radiologist in comparison to an emergency medicine specialist (96% vs. 90%). Conclusion: Base on the findings of the present meta-analysis, screening performance characteristic of ultrasonography in detection of thoracic bone fractures was found to be higher than radiography. However, these characteristics were more prominent in detection of rib fractures and in cases where was performed by a radiologist.

Keywords

Thoracic fractures; ultrasonography; radiography; diagnostic tests, routine

References

Hendrich C, Finkewitz U, Berner W. Diagnostic value of ultrasonography and conventional radiography for the assessment of sternal fractures. Injury. 1995;26(9):601-4.

Engin G, Yekeler E, Güloǧlu R, Acunaş B, Acunaş G. US versus conventional radiography in the diagnosis of sternal fractures. Acta Radiol. 2000;41(3):296-9.

Barnea Y, Kashtan H, Skornick Y, Werbin N. Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 2002;45(1):43-6.

Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma Acute Care Surg. 2003;54(3):478-85.

Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma Acute Care Surg. 2000;48(6):1040-7.

Forouzanfar MM, Safari S, Niazazari M, et al. Clinical decision rule to prevent unnecessary chest X-ray in patients with blunt multiple traumas. Emerg Med Australas. 2014;26(6):561-6.

Wongwaisayawan S, Suwannanon R, Prachanukool T, Sricharoen P, Saksobhavivat N, Kaewlai R. Trauma Ultrasound. Ultrasound Med Biol. 2015:[In press].

Hurley ME, Keye GD, Hamilton S. Is ultrasound really helpful in the detection of rib fractures? Injury. 2004;35(6):562-6.

Saraogi A. Lung ultrasound: Present and future. Lung India. 2015;32(3):250-7.

Jin W, Yang DM, Kim HC, Ryu KN. Diagnostic values of sonography for assessment of sternal fractures compared with conventional radiography and bone scans. J Ultrasound Med. 2006;25(10):1263-8.

Rainer TH, Griffith JF, Lam E, Lam PKW, Metreweli C. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma. 2004;56(6):1211-3.

Uzuna M, Beksaça B, Karab A, Küçükdurmazc F, Kırcalıd BA, Tetika C. Ultrasonography as a better diagnostic efficiency in rib fracture. J Experiment Clin Med. 2013;30:133-5.

Chan SS. Emergency bedside ultrasound for the diagnosis of rib fractures. Am J Emerg Med. 2009;27(5):617-20.

Traub M, Stevenson M, McEvoy S, et al. The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury. 2007;38(1):43-7.

Ebrahimi A, Yousefifard M, Mohammad Kazemi H, et al. Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis. Tanaffos. 2014;13(4):29-40.

Hosseini M, Yousefifard M, Aziznejad H, Nasirinezhad F. The Effect of bone marrow derived mesenchymal stem cell transplantation on allodynia and hyperalgesia in neuropathic animals: A systematic review with meta-analysis. Biol Blood Marrow Transplant. 2015: [In press].

Wootton-Gorges SL, Stein-Wexler R, Walton JW, Rosas AJ, Coulter KP, Rogers KK. Comparison of computed tomography and chest radiography in the detection of rib fractures in abused infants. Child Abuse Negl. 2008;32(6):659-63.

Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI. Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med. 2010;17(7):687-93.

Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008-12.

Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41(8):862-8.

You JS, Chung YE, Kim D, Park S, Chung SP. Role of sonography in the emergency room to diagnose sternal fractures. J Clin Ultrasound. 2010;38(3):135-7.

Szucs-Farkas Z, Lautenschlager K, Flach PM, et al. Bone images from dual-energy subtraction chest radiography in the detection of rib fractures. Eur J Radiol. 2011;79(2):e28-32.

Yazkan R, Ergene G, Tulay CM, Güneş S, Han S. Comparison of Chest Computed Tomography and Chest X-Ray in the Diagnosis of Rib Fractures in Patients with Blunt Chest Trauma. JAEM. 2012;11:171-5.

Błasińska-Przerwa K, Pacho R, Bestry I. Pneumonol Alergol Pol. Pneumonologia Alergologia Polska. 2013;81(6):518-26.

Chardoli M, Hasan-Ghaliaee T, Akbari H, Rahimi-Movaghar V. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma. Chin J Traumatol. 2013;16(6):351-4.

Hoffstetter P, Dornia C, Schafer S, et al. Diagnostic significance of rib series in minor thorax trauma compared to plain chest film and computed tomography. J Trauma Manag Outcomes. 2014;8:10.

Park JB, Cho YS, Choi HJ. Diagnostic accuracy of the inverted grayscale rib series for detection of rib fracture in minor chest trauma. Am J Emerg Med. 2015;33(4):548-52.

Sistrom CL, Mergo PJ. A simple method for obtaining original data from published graphs and plots. Am J Roentgenol. 2000;174(5):1241-4.

Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529-36.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557.

Abbasi S, Farsi D, Hafezimoghadam P, Fathi M, Zare MA. Accuracy of emergency physician-performed ultrasound in detecting traumatic pneumothorax after a 2-h training course. Eur J Emerg Med. 2013;20(3):173-7.

Bui-Mansfield LT, Chen DC, O'Brien SD. Accuracy of ultrasound of musculoskeletal soft-tissue tumors. Am J Roentgenol. 2015;204(2):W218.

Fine D, Perring S, Herbetko J, Hacking C, Fleming J, Dewbury K. Three-dimensional (3D) ultrasound imaging of the gallbladder and dilated biliary tree: reconstruction from real-time B-scans. Br J Radiol. 1991;64(767):1056-7.

Lee JH, Jeong YK, Park KB, Park JK, Jeong AK, Hwang JC. Operator-dependent techniques for graded compression sonography to detect the appendix and diagnose acute appendicitis. Am J Roentgenol. 2005;184(1):91-7.

Majumdar S, Kumar PS, Pandit A. Effect of liquid-phase properties on ultrasound intensity and cavitational activity. Ultrason Sonochem. 1998;5(3):113-8.

Dietrich CF, Mathis G, Cui XW, Ignee A, Hocke M, Hirche TO. Ultrasound of the pleurae and lungs. Ultrasound Med Biol. 2015;41(2):351-65.




DOI: http://dx.doi.org/10.22037/emergency.v4i2.9680

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