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Table 1 Characteristics of the Currently Available Systematic Reviews on the Diagnostic Accuracy of Tests

From: Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

Author(s)Population in eligible studies as described by the review authorsFractureNumber of studies includedDiagnostic testPooled Se
(95% CI)
Pooled Sp
(95% CI)
Positive LRConclusion
HISTORY TAKING
 Carpenter (2014) [32]Emergency Department.Scaphoid0    History examination alone is inadequate to rule in or rule out scaphoid fracture.
PHYSICAL EXAMINATION
 Carpenter (2014) [32]Emergency Department.Scaphoid6ASB tenderness0.96 (0.92–0.98)0.39 (0.36–0.43) Except for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, physical examination alone is inadequate to rule in or rule out scaphoid fracture.
6LTC0.82 (0.77–0.87)0.58 (0.54–0.62) 
7Ultrasound fibration pain0.67 (0.59–0.75)0.57 (0.51–0.62) 
3Clamp sign0.73 (0.67–0.78)0.92 (0.89–0.95) 
3Painfull ulnar deviation0.77 (0.68–0.83)0.42 (0.34–0.49) 
3STT0.92 (0.86–0.96)0.47 (0.43–0.52) 
2Resisted supination pain0.94 (0.85–0.98)0.74 (0.63–0.84) 
 Burrows (2014) [33]Not specifiedScaphoid5ASB tenderness  1.52 (1.12–2.06)Three clinical tests with statistically significant diagnostic validity were identified. In isolation, the clinical significance of each is questionable.
7Scaphoid compression test  2.37 (1.27–4.41)
3STT  1.67 (1.33–2.09)
 Mallee (2015) [34]Patients presenting to the emergency department or outpatient clinicScaphoid8ASB tenderness0.87–1.00 a0.03–0.98 b Anatomical snuff box tenderness was the most sensitive clinical test. The low specificity of the clinical tests may result in a considerable number of over-treated patients. Combining tests improved the post-test fracture probability.
8LTC0.48–1.00 a0.22–0.97 b 
4STT0.82–1.00 a0.17–0.57 b 
4Painfull ulnar deviation0.67–1.00 a0.17–0.60 b 
4ASB swelling0.67–0.77 a0.37–0.72 b 
IMAGING
 Carpenter (2014) [32]Emergency Department.Scaphoid5X-ray fat pad0.82 (0.76–0.86)0.72 (0.68–0.75) MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x-rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.
18BS0.91 (0.87–0.94)0.86 (0.83–0.88) 
6US0.80 (0.67–0.90)0.87 (0.81–0.91) 
8CT0.83 (0.83–0.89)0.97 (0.94–0.98) 
13MRI0.96 (0.92–0.99)0.98 (0.96–0.99) 
 Yin (2012) [35]Not specifiedScaphoid28Follow-up radiographs0.91 (0.81–0.98)1.00 (0.99–1.00) If we acknowledge the lack of a reference standard for diagnosing suspected scaphoid fractures, MRI is the most accurate test; follow-up radiographs and CT may be less sensitive, and bone scintigraphy less specific.
18BS0.98 (0.96–0.99)0.94 (0.91–0.95) 
15MRI0.98 (0.95–0.99)1.00 (0.99–1.00) 
9CT0.85 (0.74–0.94)1.00 (0.98–1.00) 
 Yin (2010) [36]Not specifiedScaphoid15BS0.97 (0.93–0.99)0.89 (0.83–0.94) Bone scintigraphy and MRI have equally high sensitivity and high diagnostic value for excluding scaphoid fracture; however, MRI is more specific and better for confirming scaphoid fracture.
10MRI0.96 (0.91–0.99)0.99 (0.96–1.00) 
6CT0.93 (0.83–0.98)0.99 (0.96–1.00) 
 Mallee (2014) [34]People of all ages who presented at hospital or clinicScaphoid6BS0.99 (0.69–1.00)0.86 (0.73–0.94) Bone scintigraphy is statistically the best diagnostic modality to establish a definitive diagnosis in clinically suspected fractures when radiographs appear normal. The number of overtreated patients is substantially lower with CT and MRI.
4CT0.72 (0.36–0.92)0.99 (0.71–1.00) 
5MRI0.88 (0.64–0.97)1.00 (0.38–1.00) 
 Kwee (2018) [37]Not specifiedScaphoid7US0.86 (0.74–0.93)0.84 (0.72–0.91) Ultrasound can diagnose radiographically occult scaphoid fracture with a fairly high degree of accuracy.
 Ali (2018) [38]Not specifiedScaphoid6US0.94 (0.78–1.00)0.89 (0.78–1.00) US reveals high sensitivity and specificity in scaphoid fracture diagnosis.
  1. ASB Anatomic snuff-box, LTC Longitudinal (thumb) compression test, STT Scaphoid tubercle tenderness, BS Bone Scintigraphy, US Ultrasound, CT Computed TomographyMRI: Magnetic Resonance Imaging
  2. aSensitivity range described, because of the high heterogeneity Mallee et al. [34] refrained from calculating pooled estimate points
  3. bSpecificity Range described, because of the high heterogeneity Mallee et al. [34] refrained from calculating pooled estimate points