The diagnostic accuracy of ultrasound in the detection of foot and ankle fractures: a systematic review and meta-analysis

Abstract

Aims: Foot and ankle injuries are a common presenting complaint in the emergency department. The diagnosis of foot and ankle fractures is conventionally accomplished through X-rays. Whether ultrasound (US) can be considered as a primary scanning modality is still a controversial issue; therefore, we did a meta-analysis to synthesize the diagnostic performance ofultrasound for foot and ankle fractures.Material and methods: A comprehensive search was carried out to identify studies in which patients with clinically suspected foot and ankle fractures were assessed by US. Two investigators independently screened the literature and extracted the data. Any discrepancies were resolved via discussion. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and pooled sensitivity and specificity of various US findings were determined.Results: Ten studies with a total of 1065 patients were included. There was significant heterogeneity across the included studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for the diagnosis of foot and ankle fractures by US were 0.96 (95% confidence interval [CI], 0.90-0.99), 0.94 (95% CI, 0.88-0.97), 15.0 (95% CI, 7.9-28.6), 0.04 (95% CI, 0.02-0.11), and 367 (95% CI, 101-1338), respectively. Furthermore, the summary receiver operating characteristic area under the curve was calculated to be 0.99.Conclusions: Ultrasound has an excellent diagnostic performance for foot and ankle fractures and should be considered as a primary and radiation-free scanning modality in the diagnosis of foot and ankle fractures.

Integration of ultrasound radiomics features and clinical factors: A nomogram model for identifying the Ki-67 status in patients with breast carcinoma

“…In contrast, in the present study, the AUC value of the nomogram model was more satisfactory than these reported above in the test set (AUC, 0.808 vs. 0.749 vs. 0.72). In addition, compared with MRI, ultrasound considered as a radiation-free nature, convenient, and reasonable price technology is universally used for breast tumor screening and diagnosis ( 30 , 31 ). Due to the relatively high predictive performance, it is considered that the nomogram model could be used as a noninvasive and reliable tool in predicting Ki-67 status and assist clinicians for preoperative decision-making.…”

What is the diagnostic accuracy of ultrasound versus x-ray for closed metatarsal fractures?

“…A randomized controlled trial (RCT) of 123 adolescents with high levels of sleep problems and anxiety evaluated whether cognitive behavioral and mindfulness-based group sleep improvement therapy would improve adolescents' anxiety. 1 Patients were randomized to either a sleep SENSE intervention or a control "study skills" group. The sleep SENSE intervention involves sleep education, sleep hygiene, stimulus control, and cognitive restructuring, mindfulness, savoring, and anxiety-specific components.…”

“…A 2021 meta-analysis of 10 prospective diagnostic cohort studies (N=1,065) evaluated the performance of ultrasound (US) versus X-ray for detecting foot/ankle fractures. 1 The studies included patients (mean ages 8–53 years old, 48% male) with foot/ankle injuries. The prevalence of fractures across studies was 10% to 40%.…”

Role of point-of-care ultrasound (POCUS) in the diagnosis of an abscess in paediatric skin and soft tissue infections: a systematic review and meta-analysis

“…Several studies have described the application of POCUS in guiding diagnosis and management of SSTI in adults by the ED physicians, showing the superior sensitivity and specificity of POCUS compared with clinical assessment only and the positive role of POCUS in improving bedside decision-making in adults with SSTI [7][8][9][10][11]. The use of POCUS in the diagnosis of an abscess in children with SSTI is increasing in paediatric ED [12][13][14][15][16][17][18] and POCUS is frequently used as the initial imaging technology of choice for the evaluation of paediatric SSTI, as it is an effective, highly available, noninvasive, economical [19,20] and non-radiating imaging modality. However, prior studies in the field of POCUS use for paediatric SSTI include small sample size, single-centre studies and the lack of integration of findings into clinical decision-making.…”