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Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review

Elbow traumas represent a relatively common condition in clinical practice. However, there is a lack of evidence regarding the most accurate tests for screening these potentially serious conditions and excluding elbow fractures. The purpose of this investigation was to analyze the literature concern...

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Autores principales: Breda, Giorgio, De Marco, Gianluca, Cesaraccio, Pierfranco, Pillastrini, Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Shoulder and Elbow Society 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10277706/
https://www.ncbi.nlm.nih.gov/pubmed/35971600
http://dx.doi.org/10.5397/cise.2022.00948
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author Breda, Giorgio
De Marco, Gianluca
Cesaraccio, Pierfranco
Pillastrini, Paolo
author_facet Breda, Giorgio
De Marco, Gianluca
Cesaraccio, Pierfranco
Pillastrini, Paolo
author_sort Breda, Giorgio
collection PubMed
description Elbow traumas represent a relatively common condition in clinical practice. However, there is a lack of evidence regarding the most accurate tests for screening these potentially serious conditions and excluding elbow fractures. The purpose of this investigation was to analyze the literature concerning the diagnostic accuracy of clinical tests for the detection or exclusion of suspected elbow fractures. A systematic review was performed using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. Literature databases including PubMed, Cumulative Index to Nursing and Allied Health Literature, Diagnostic Test Accuracy, Cochrane Library the Web of Science, and ScienceDirect were searched for diagnostic accuracy studies of subjects with suspected traumatic elbow fracture investigating clinical tests compared to imaging reference tests. The risk of bias in each study was assessed independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. Twelve studies (4,485 patients) were included. Three different types of index tests were extracted. In adults, these tests were very sensitive, with values up to 98.6% (95% confidence interval [CI], 95.0%–99.8%). The specificity was very variable, ranging from 24.0% (95% CI, 19.0%–30.0%) to 69.4% (95% CI, 57.3%–79.5%). The applicability of these tests was very high, while overall studies showed a medium risk of bias. Elbow full range of motion test, elbow extension test, and elbow extension and point tenderness test appear to be useful in the presence of a negative test to exclude fracture in a majority of cases. The specificity of all tests, however, does not allow us to draw useful conclusions because there was a great variability of results obtained. LEVEL OF EVIDENCE: IV.
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spelling pubmed-102777062023-06-20 Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review Breda, Giorgio De Marco, Gianluca Cesaraccio, Pierfranco Pillastrini, Paolo Clin Shoulder Elb Review Elbow traumas represent a relatively common condition in clinical practice. However, there is a lack of evidence regarding the most accurate tests for screening these potentially serious conditions and excluding elbow fractures. The purpose of this investigation was to analyze the literature concerning the diagnostic accuracy of clinical tests for the detection or exclusion of suspected elbow fractures. A systematic review was performed using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. Literature databases including PubMed, Cumulative Index to Nursing and Allied Health Literature, Diagnostic Test Accuracy, Cochrane Library the Web of Science, and ScienceDirect were searched for diagnostic accuracy studies of subjects with suspected traumatic elbow fracture investigating clinical tests compared to imaging reference tests. The risk of bias in each study was assessed independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. Twelve studies (4,485 patients) were included. Three different types of index tests were extracted. In adults, these tests were very sensitive, with values up to 98.6% (95% confidence interval [CI], 95.0%–99.8%). The specificity was very variable, ranging from 24.0% (95% CI, 19.0%–30.0%) to 69.4% (95% CI, 57.3%–79.5%). The applicability of these tests was very high, while overall studies showed a medium risk of bias. Elbow full range of motion test, elbow extension test, and elbow extension and point tenderness test appear to be useful in the presence of a negative test to exclude fracture in a majority of cases. The specificity of all tests, however, does not allow us to draw useful conclusions because there was a great variability of results obtained. LEVEL OF EVIDENCE: IV. Korean Shoulder and Elbow Society 2022-08-16 /pmc/articles/PMC10277706/ /pubmed/35971600 http://dx.doi.org/10.5397/cise.2022.00948 Text en Copyright © 2023 Korean Shoulder and Elbow Society https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Breda, Giorgio
De Marco, Gianluca
Cesaraccio, Pierfranco
Pillastrini, Paolo
Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review
title Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review
title_full Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review
title_fullStr Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review
title_full_unstemmed Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review
title_short Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review
title_sort diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10277706/
https://www.ncbi.nlm.nih.gov/pubmed/35971600
http://dx.doi.org/10.5397/cise.2022.00948
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