Diagnostic Accuracy of Ultrasonography in Retained Soft Tissue Foreign Bodies: A Systematic Review and Meta-analysis

Abstract

Objectives: Open wounds with the potential for retained foreign bodies are frequently seen in the emergency department (ED). Common foreign bodies, such as wood or glass, are often missed on physical examination and conventional radiography. The increased use of ultrasonography (US) in the ED presents an opportunity to better identify retained soft tissue foreign bodies, and understanding of its test characteristics is desirable. The authors set out to determine the test characteristics of US for detection of soft tissue foreign bodies by performing a systematic review and meta-analysis of the existing literature.Methods: This was a thorough, systematic review of OVID Medline, SCOPUS, and Cochrane databases and a limited review of Directory of Open Access Journals, Google Scholar, and ClinicalTrials.gov to identify clinical studies examining the diagnostic accuracy of US in the identification of retained soft tissue foreign bodies. Studies were selected for full-text review by two independent reviewers to determine if they met inclusion criteria. Results were pooled for test characteristics using STATA and assessed for risk of bias and applicability using the QUADAS-2 tool.Results: This systematic search strategy identified 5,059 unique articles, and 17 articles met inclusion criteria. Pooled sensitivity and specificity were, respectively, 72% (95% confidence interval [CI] = 57% to 83%) and 92% (95% CI = 88% to 95%). Overall quality of the studies was low and interstudy heterogeneity was high (I 2 = 90%, 95% CI = 80% to 100%).Conclusions: Ultrasonography is highly specific and moderately sensitive in the identification of retained soft tissue foreign bodies; however, studies to date have a high degree of heterogeneity and a high risk of bias.ACADEMIC EMERGENCY MEDICINE 2015;22:777-787

Comparison of Cone Beam Computed Tomography and ultrasonography with two types of probes in the detection of opaque and non-opaque foreign bodies

“…A recent systemic review concluded that US could be a powerful tool for the detection of FBs in the skin and soft tissues [10]. While Aras et al [1] investigated FBs with US using a single linear probe, Valizadeh et al [6] examined FBs with US using linear probes in different set-ups for different FBs.…”

“…However, it may be unsuitable for those FBs which are in deep regions and inside the airfilled cavities [1,9]. In a recent study, Davis et al [10] published a systemic review and meta-analysis focused on the detection of FBs with US. They concluded that US could be a useful diagnostic tool in the evaluation of FBs located in the skin and soft tissues.…”

Evaluation of Visibility of Foreign Bodies in the Maxillofacial Region: Comparison of Computed Tomography, Cone Beam Computed Tomography, Ultrasound and Magnetic Resonance Imaging

“…It is affordable and does not employ X ray beams and the obtained images are readily available for evaluation. However, this modality is not suitable for detection of objects in deep tissues or air filled cavities (14). …”

Role of Ultrasound in the Identi cation of Longitudinal Axis in Soft-Tissue Foreign Body Extraction

“…In one retrospective study of 200 patients Anderson et al showed that conventional radiographic studies identified wood foreign bodies only 15% of the time 4. Bray et al demonstrated that US has a sensitivity of 94% and specificity of 99% in the identification of STFBs.3 More recent studies, including a meta-analysis conducted by Davis et al showed that US has moderate sensitivity of 72% but still high specificity of 92% in the detection of STFBs 5. In addition, US can accurately measure the size of a lodged foreign body within ± 1 mm 3.…”