Evidence map›Paper›PMID 33008428›Full record

SynthesisWorld journal of emergency surgery : WJES2020

Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis.

Yohei Okada, Norihiro Nishioka, Shigeru Ohtsuru, Yasushi Tsujimoto

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in World journal of emergency surgery : WJES, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Article
  5. Article
  6. Article
  7. Diagnostic accuracy of clinical examination to identify life- and limb-threatening injuries in trauma patients.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Yohei OkadaDepartment of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Shogoin Kawaramachi 54, Sakyo, Kyoto, 606-8507, Japan. yokada-kyf@umin.ac.jp.ORCID 0000-0002-2266-476X
Norihiro NishiokaDepartment of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.
Shigeru OhtsuruDepartment of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Shogoin Kawaramachi 54, Sakyo, Kyoto, 606-8507, Japan.
Yasushi TsujimotoDepartment of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients.

methodsStudies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis.

resultsThe median prevalence of pelvic fracture was 10.5% (interquartile range, 5.1-16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761-0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847-0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560-0.932). For threshold probability < 0.01 with 10-15% prevalence, the net benefit of imaging tests was higher than that of physical examination.

conclusionImaging tests should be performed in all trauma patients regardless of findings from physical examination or patients' levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

Indexed as

Fractures, BoneHumansPelvic BonesPhysical ExaminationWounds, NonpenetratingDecision curve analysisDiagnostic accuracyImagingNet-benefitPelvic fracturesPhysical examinationTrauma

Identifiers

PMID33008428
PMCPMC7531119

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.