title: Ultrasound for Distal Forearm Fracture: A Systematic Review and Diagnostic Meta-Analysis.
abstract: To determine the diagnostic accuracy of ultrasound for detecting distal forearm fractures.
  
  
  
  A systematic review and diagnostic meta-analysis was performed according to the PRISMA statement. We searched MEDLINE, Web of Science and the Cochrane Library from inception to September 2015. All prospective studies of the diagnostic accuracy of ultrasound versus radiography as the reference standard were included. We excluded studies with a retrospective design and those with evidence of verification bias. We assessed the methodological quality of the included studies with the QUADAS-2 tool. We performed a meta-analysis of studies evaluating ultrasound to calculate the pooled sensitivity and specificity with 95% confidence intervals (CI95%) using a bivariate model with random effects. Subgroup and sensitivity analysis were used to examine the effect of methodological differences and other study characteristics.
  
  
  
  Out of 867 publications we included 16 studies with 1,204 patients and 641 fractures. The pooled test characteristics for ultrasound were: sensitivity 97% (CI95% 93-99%), specificity 95% (CI95% 89-98%), positive likelihood ratio (LR) 20.0 (8.5-47.2) and negative LR 0.03 (0.01-0.08). The corresponding pooled diagnostic odds ratio (DOR) was 667 (142-3,133). Apparent differences were shown for method of viewing, with the 6-view method showing higher specificity, positive LR, and DOR, compared to the 4-view method.
  
  
  
  The present meta-analysis showed that ultrasound has a high accuracy for the diagnosis of distal forearm fractures in children when used by proper viewing method. Based on this, ultrasound should be considered a reliable alternative, which has the advantages of being radiation free.
authors.affiliation: Department of Emergency Medicine, Isala hospital, Zwolle, the Netherlands.
authors.forename: Djoke
authors.initials: D
authors.lastname: Douma-den Hamer
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Marco H
authors.initials: MH
authors.lastname: Blanker
authors.affiliation: Department of Clinical Epidemiology, Isala hospital, Zwolle, the Netherlands.
authors.forename: Mireille A
authors.initials: MA
authors.lastname: Edens
authors.affiliation: Department of Emergency Medicine, Isala hospital, Zwolle, the Netherlands.
authors.forename: Lonneke N
authors.initials: LN
authors.lastname: Buijteweg
authors.affiliation: Department of Radiology, Isala hospital, Zwolle, the Netherlands.
authors.forename: Martijn F
authors.initials: MF
authors.lastname: Boomsma
authors.affiliation: Department of Trauma Surgery, Isala hospital, Zwolle, the Netherlands.
authors.forename: Sven H
authors.initials: SH
authors.lastname: van Helden
authors.affiliation: Department of Emergency Medicine, Isala hospital, Zwolle, the Netherlands.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Mauritz
mesh_terms: D005542:Forearm / Q000000981:diagnostic imaging*; D006801:Humans; D016013:Likelihood Functions; D016017:Odds Ratio; D011446:Prospective Studies; D012372:ROC Curve; D011885:Radius Fractures / Q000000981:diagnostic imaging*; D012015:Reference Standards; D015203:Reproducibility of Results; D012306:Risk; D012680:Sensitivity and Specificity; D014458:Ulna Fractures / Q000000981:diagnostic imaging*; D014463:Ultrasonography