Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis.
BACKGROUND
This systematic review aimed at evaluating the diagnostic accuracy of pulse examination in detecting surgical arterial lesions associated with knee dislocation.


METHODS
MEDLINE, CINAHL, and SportDiscus databases were searched in all languages to review articles concerning human knee dislocation and associated vascular injuries.


RESULTS
We reviewed 116 articles. Seven met our inclusion criteria, providing detailed data on 284 injuries. Pooled data demonstrated that abnormal pedal pulses present a sensitivity of 0.79 (95% confidence interval [CI], 0.64-0.89), a specificity of 0.91 (95% CI 0.78-0.96), a positive predictive value of 0.75 (95% CI, 0.61-0.83), and a negative predictive value of 0.93 (95% CI, 0.85-.96).


CONCLUSIONS
Our findings suggest that the isolated presence of abnormal pedal pulses on initial examination of patients with knee dislocations is not sensitive enough to detect a surgical vascular injury. On the basis of this meta-analysis, an algorithm for the evaluation of these patients is presented.
Barnes
Christopher J
CJ
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Pietrobon
Ricardo
R
Higgins
Laurence D
LD
D000328:Adult; D000465:Algorithms; D000792:Angiography / Q000379:methods; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000175:diagnosis* / Q000601:surgery*; D007718:Knee Injuries / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D016017:Odds Ratio; D010808:Physical Examination / Q000379:methods*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D011237:Predictive Value of Tests; D011674:Pulse; D012680:Sensitivity and Specificity