Article Figures & Data
- Figure 1
Flow diagram of studies identified and included according to PRISMA. PICO, Population, Intervention, Comparison, Outcome; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
- Figure 2
Proportion of studies rated as ‘low risk’. ‘high risk’ or ‘unclear risk’ for each of the QUADAS items for the 11 included studies for the diagnosis of fractures of the rib cage, thoracolumbar spine, and pelvic ring. QUADAS, Quality Assessment of Diagnostic Accuracy Studies; XR, plain radiography.
- Table 1
Research question according to PICO criteria
Population Geriatric patient ≥65 years of age, ground level fall (GLF), fall from: standing position (including snow/ice), low furniture, being carried or supported by a second person, wheel chair, stairs (up to 1 m height), minor trauma/injury, low energy trauma. (Fulfilled if ≥80% of eligible patients met the criteria) Intervention CT, whole body CT, full body CT, computed axial tomography (CAT scan), computer aided tomography, positron emission tomography (PET), single-photon emission CT (SPECT), specifically of: torso, ribs, abdomen, spine, pelvis Comparison No measure or any but CT; in the same region as the intervention Outcome Fracture PICO, Population, Intervention, Comparison, Outcome.
- Table 2
Measures of diagnostic accuracy (CI 95%) of XR for fracture detection in the respective body regions calculated for the included studies
Publication Sensitivity
(%)Specificity
(%)PPV
(%)NPV
(%)LR+ LR− Accuracy
(%)Thorax and rib cage Lampart et al20 22.7 (7.8–45.4) 95.7 (85.2–99.5) 71.4 (34.5–92.2) 72.1 (67.2–76.6) 5.2 (1.1–24.9) 0.8 (0.6–1.0) 72.1 (59.9–82.3) Singleton et al19 41.7 (31.7–52.2) 100 (98.4–100) 100 (n/a) 80.7 (77.9–83.2) n/a 0.6 (0.5–0.7) 83.0 (78.5–86.9) Thoracolumbar spine Karul et al28 49.2 (36.6–61.9) 54.8 (38.7–70.2) 62.8 (52.7–71.8) 41.1 (32.6–50.1) 1.1 (0.7–1.7) 0.9 (0.6–1.3) 51.4 (41.5–61.2) Lampart et al20 (thoracic spine) 40.0 (19.1–64.0) 100 (75.3–100) 100 (n/a) 52.0 (43.1–60.8) n/a 0.6 (0.4–0.9) 63.6 (45.1–79.6) Lampart et al20 (lumbar spine) 57.8 (42.2–72.3) 100 (88.8–100) 100 (n/a) 62.0 (53.7–69.7) n/a 0.4 (0.3–0.6) 75.0 (63.7–84.2) Hip and pelvic ring Böhme et al21 n/a n/a n/a n/a n/a n/a n/a Dunker et al22 n/a n/a n/a n/a n/a n/a n/a Eggenberger et al29 n/a n/a n/a n/a n/a n/a n/a Heikal et al23 10.5 (2.9–24.8) 100 (87.2–100) 100 (n/a) 44.3 (41.6–47) n/a 0.9 (0.8–1.0) 47.7 (35.2–60.5) Lampart et al20 31.4 (23.3–40.5) 98.6 (92.6–99.9) 97.4 (84.2–99.6) 46.5 (43.4–49.5) 22.9 (3.2–163.5) 0.7 (0.6–0.8) 56.7 (49.4–63.8) Natoli et al24 n/a n/a n/a n/a n/a n/a n/a Nüchtern et al27 0 (0–7.4) 66.7 (34.9–90.1) 0 14.3 (10.5–19.9) 0 1.5 (1.0–2.2) 13.3 (5.9–24.6) Schicho et al25 52.2 (45.5–58.7) 95.5 (92.5–97.5) 89.6 (83.6–93.6) 72.7 (69.9–75.4) 11.6 (6.8–19.6) 0.5 (0.4–0.6) 76.9 (73.2–80.4) Thomas et al26 0 (0–3.4) 100 (96.1–100) n/a 46.7 (46.7–46.7) n/a 1. (1.0–1.0) 46.7 (39.7–53.9) LR+, positive likelihood ratios; LR−, negative likelihood ratio; n/a, not applicable; NPV, negative predictive value; PPV, positive predictive value; XR, plain radiography.
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