Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis.
BACKGROUND
The potential benefit of ultrasonography for detection of thoracic bone fractures has been proven in various surveys but no comprehensive conclusion has been drawn yet; therefore, the present study aimed to conduct a thorough meta-analytic systematic review on this subject.


METHODS
Two reviewers independently carried out a comprehensive systematic search in Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest databases. Data were summarized as true positive, false positive, true negative and false negative and were analyzed via STATA 11.0 software using a mixed-effects binary regression model. Sources of heterogeneity were further assessed through subgroup analysis.


RESULTS
Data on 1667 patients (807 subjects with and 860 cases without thoracic fractures), whose age ranged from 0 to 92 years, were extracted from 17 surveys. Pooled sensitivity and specificity of ultrasonography in detection of thoracic bone fractures were 0.97 (95% CI: 0.90-0.99; I2= 88.88, p<0.001) and 0.94 (95% CI: 0.86-0.97; I2= 71.97, p<0.001), respectively. The same measures for chest radiography were found to be 0.77 (95% CI: 0.56-0.90; I2= 97.76, p<0.001) and 1.0 (95% CI: 0.91-1.00; I2= 97.24, p<0.001), respectively. The sensitivity of ultrasonography was higher in detection of rib fractures, compared to fractures of sternum or clavicle (97% vs. 91%). Moreover, the sensitivity was found to be higher when the procedure was carried out by a radiologist in comparison to an emergency medicine specialist (96% vs. 90%).


CONCLUSIONS
Base on the findings of the present meta-analysis, screening performance characteristic of ultrasonography in detection of thoracic bone fractures was found to be higher than radiography. However, these characteristics were more prominent in detection of rib fractures and in cases where was performed by a radiologist.
Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mahmoud
M
Yousefifard
Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Masoud
M
Baikpour
Department of Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Parisa
P
Ghelichkhani
Department of Occupational Health Engineering, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Hadi
H
Asady
Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abolfazl
A
Darafarin
Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mohammad Reza
MR
Amini Esfahani
Sina Trauma and Surgery Research Center, Tehran University Medical Sciences, Tehran, Iran.; Department of Epidemiology and Biostatistics, school of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Mostafa
M
Hosseini
Sina Trauma and Surgery Research Center, Tehran University Medical Sciences, Tehran, Iran.
Mehdi
M
Yaseri
Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Saeed
S
Safari
Thoracic fractures; diagnostic tests; radiography; routine; ultrasonography