title: Is there sufficient evidence for tuning fork tests in diagnosing fractures? A systematic review.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of tuning fork tests for detecting fractures.
  
  
  METHODS
  Systematic review of primary studies evaluating the diagnostic accuracy of tuning fork tests for the presence of fracture.
  
  
  METHODS
  We searched MEDLINE, CINAHL, AMED, EMBASE, Sports Discus, CAB Abstracts and Web of Science from commencement to November 2012. We manually searched the reference lists of any review papers and any identified relevant studies.
  
  
  METHODS
  Two reviewers independently reviewed the list of potentially eligible studies and rated the studies for quality using the QUADAS-2 tool. Data were extracted to form 2×2 contingency tables. The primary outcome measure was the accuracy of the test as measured by its sensitivity and specificity with 95% CIs.
  
  
  RESULTS
  We included six studies (329 patients), with two types of tuning fork tests (pain induction and loss of sound transmission). The studies included patients with an age range 7-60 years. The prevalence of fracture ranged from 10% to 80%. The sensitivity of the tuning fork tests was high, ranging from 75% to 100%. The specificity of the tests was highly heterogeneous, ranging from 18% to 95%.
  
  
  CONCLUSIONS
  Based on the studies in this review, tuning fork tests have some value in ruling out fractures, but are not sufficiently reliable or accurate for widespread clinical use. The small sample size of the studies and the observed heterogeneity make generalisable conclusion difficult.
authors.affiliation: Centre for Research in Evidence Based Practice, Faculty of Health Sciences & Medicine, Bond University, Robina, Australia.
authors.forename: Kayalvili
authors.initials: K
authors.lastname: Mugunthan
authors.affiliation: Centre for Research in Evidence Based Practice, Faculty of Health Sciences & Medicine, Bond University, Robina, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Doust
authors.affiliation: AnatomischesInstitut, CAU zu Kiel, Olshausenstrasse, Kiel, Germany.
authors.forename: Bodo
authors.initials: B
authors.lastname: Kurz
authors.affiliation: Centre for Research in Evidence Based Practice, Faculty of Health Sciences & Medicine, Bond University, Robina, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
mesh_terms: D001301:Audiometry, Pure-Tone / Q000295:instrumentation*; D001844:Bone Conduction; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014732:Vibration
keywords: Qualitative Research
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