Point‐of‐care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma
Background Point‐of‐care sonography (POCS) has emerged as the screening modality of choice for suspected body trauma in many emergency departments worldwide. Its best known application is FAST (focused abdominal sonography for trauma). The technology is almost ubiquitously available, can be performe...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2018-12, Vol.2018 (12), p.CD012669 |
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| creator | Stengel, Dirk Leisterer, Johannes Ferrada, Paula Ekkernkamp, Axel Mutze, Sven Hoenning, Alexander Stengel, Dirk |
| description | Background
Point‐of‐care sonography (POCS) has emerged as the screening modality of choice for suspected body trauma in many emergency departments worldwide. Its best known application is FAST (focused abdominal sonography for trauma). The technology is almost ubiquitously available, can be performed during resuscitation, and does not expose patients or staff to radiation. While many authors have stressed the high specificity of POCS, its sensitivity varied markedly across studies. This review aimed to compile the current best evidence about the diagnostic accuracy of POCS imaging protocols in the setting of blunt thoracoabdominal trauma.
Objectives
To determine the diagnostic accuracy of POCS for detecting and excluding free fluid, organ injuries, vascular lesions, and other injuries (e.g. pneumothorax) compared to a diagnostic reference standard (i.e. computed tomography (CT), magnetic resonance imaging (MRI), thoracoscopy or thoracotomy, laparoscopy or laparotomy, autopsy, or any combination of these) in patients with blunt trauma.
Search methods
We searched Ovid MEDLINE (1946 to July 2017) and Ovid Embase (1974 to July 2017), as well as PubMed (1947 to July 2017), employing a prospectively defined literature and data retrieval strategy. We also screened the Cochrane Library, Google Scholar, and BIOSIS for potentially relevant citations, and scanned the reference lists of full‐text papers for articles missed by the electronic search. We performed a top‐up search on 6 December 2018, and identified eight new studies which may be incorporated into the first update of this review.
Selection criteria
We assessed studies for eligibility using predefined inclusion and exclusion criteria. We included either prospective or retrospective diagnostic cohort studies that enrolled patients of any age and gender who sustained any type of blunt injury in a civilian scenario. Eligible studies had to provide sufficient information to construct a 2 x 2 table of diagnostic accuracy to allow for calculating sensitivity, specificity, and other indices of diagnostic test accuracy.
Data collection and analysis
Two review authors independently screened titles, s, and full texts of reports using a prespecified data extraction form. Methodological quality of individual studies was rated by the QUADAS‐2 instrument (the revised and updated version of the original Quality Assessment of Diagnostic Accuracy Studies list of items). We calculated sensitivity and specificity with 95% con |
| doi_str_mv | 10.1002/14651858.CD012669.pub2 |
| format | Article |
| fullrecord | <record><control><sourceid>wiley_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6517180</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>CD012669.pub2</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4732-88d7a8179b9bda4fe18465f9302ccb1494fd9a9ab62f0543d51beb550e6f66ea3</originalsourceid><addsrcrecordid>eNqFkE1O5DAQhS00iP8rIF-gG9tJnHiDBD3Dj4QEC1hbZcfuGKXtlp0M6t0cgTNyEtxqGsFs2NglvXqvqj6ETimZUkLYGS15RZuqmc5-E8o4F9PlqNgOOlgLk7Xy60u9jw5Teiak4ILVe2i_IFXZsFIcoO4hOD-8_XsNNj8aosFjP0RIwYd5hGW3wjZE3DqY-5Ccn-OhCxF0ANWGhfPQY-efx-hMygVewuCMHxJ-cUOHVT_6Aee0cQHHaNdCn8zJx3-Enq7-PM5uJnf317ezi7uJLuuCTZqmraGhtVBCtVBaQ5t8hBUFYVorWorStgIEKM5sPqJoK6qMqipiuOXcQHGEzje5mcfCtDpvE6GXy-gWEFcygJPfFe86OQ9_ZeZZ04bkAL4J0DGkFI399FIi1-zllr3csl8nsmw8_Tr507aFnRsuNw0vrjcrqYPuInjzQ-5_U94B0UmbFw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Point‐of‐care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><source>Cochrane Library</source><creator>Stengel, Dirk ; Leisterer, Johannes ; Ferrada, Paula ; Ekkernkamp, Axel ; Mutze, Sven ; Hoenning, Alexander ; Stengel, Dirk</creator><creatorcontrib>Stengel, Dirk ; Leisterer, Johannes ; Ferrada, Paula ; Ekkernkamp, Axel ; Mutze, Sven ; Hoenning, Alexander ; Stengel, Dirk</creatorcontrib><description>Background
Point‐of‐care sonography (POCS) has emerged as the screening modality of choice for suspected body trauma in many emergency departments worldwide. Its best known application is FAST (focused abdominal sonography for trauma). The technology is almost ubiquitously available, can be performed during resuscitation, and does not expose patients or staff to radiation. While many authors have stressed the high specificity of POCS, its sensitivity varied markedly across studies. This review aimed to compile the current best evidence about the diagnostic accuracy of POCS imaging protocols in the setting of blunt thoracoabdominal trauma.
Objectives
To determine the diagnostic accuracy of POCS for detecting and excluding free fluid, organ injuries, vascular lesions, and other injuries (e.g. pneumothorax) compared to a diagnostic reference standard (i.e. computed tomography (CT), magnetic resonance imaging (MRI), thoracoscopy or thoracotomy, laparoscopy or laparotomy, autopsy, or any combination of these) in patients with blunt trauma.
Search methods
We searched Ovid MEDLINE (1946 to July 2017) and Ovid Embase (1974 to July 2017), as well as PubMed (1947 to July 2017), employing a prospectively defined literature and data retrieval strategy. We also screened the Cochrane Library, Google Scholar, and BIOSIS for potentially relevant citations, and scanned the reference lists of full‐text papers for articles missed by the electronic search. We performed a top‐up search on 6 December 2018, and identified eight new studies which may be incorporated into the first update of this review.
Selection criteria
We assessed studies for eligibility using predefined inclusion and exclusion criteria. We included either prospective or retrospective diagnostic cohort studies that enrolled patients of any age and gender who sustained any type of blunt injury in a civilian scenario. Eligible studies had to provide sufficient information to construct a 2 x 2 table of diagnostic accuracy to allow for calculating sensitivity, specificity, and other indices of diagnostic test accuracy.
Data collection and analysis
Two review authors independently screened titles, s, and full texts of reports using a prespecified data extraction form. Methodological quality of individual studies was rated by the QUADAS‐2 instrument (the revised and updated version of the original Quality Assessment of Diagnostic Accuracy Studies list of items). We calculated sensitivity and specificity with 95% confidence intervals (CI), tabulated the pairs of sensitivity and specificity with CI, and depicted these estimates by coupled forest plots using Review Manager 5 (RevMan 5). For pooling summary estimates of sensitivity and specificity, and investigating heterogeneity across studies, we fitted a bivariate model using Stata 14.0.
Main results
We included 34 studies with 8635 participants in this review. Summary estimates of sensitivity and specificity were 0.74 (95% CI 0.65 to 0.81) and 0.96 (95% CI 0.94 to 0.98). Pooled positive and negative likelihood ratios were estimated at 18.5 (95% CI 10.8 to 40.5) and 0.27 (95% CI 0.19 to 0.37), respectively. There was substantial heterogeneity across studies, and the reported accuracy of POCS strongly depended on the population and affected body area. In children, pooled sensitivity of POCS was 0.63 (95% CI 0.46 to 0.77), as compared to 0.78 (95% CI 0.69 to 0.84) in an adult or mixed population. Associated specificity in children was 0.91 (95% CI 0.81 to 0.96) and in an adult or mixed population 0.97 (95% CI 0.96 to 0.99). For abdominal trauma, POCS had a sensitivity of 0.68 (95% CI 0.59 to 0.75) and a specificity of 0.95 (95% CI 0.92 to 0.97). For chest injuries, sensitivity and specificity were calculated at 0.96 (95% CI 0.88 to 0.99) and 0.99 (95% CI 0.97 to 1.00). If we consider the results of all 34 included studies in a virtual population of 1000 patients, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 28%, POCS would miss 73 patients with injuries and falsely suggest the presence of injuries in another 29 patients. Furthermore, in a virtual population of 1000 children, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 31%, POCS would miss 118 children with injuries and falsely suggest the presence of injuries in another 62 children.
Authors' conclusions
In patients with suspected blunt thoracoabdominal trauma, positive POCS findings are helpful for guiding treatment decisions. However, with regard to abdominal trauma, a negative POCS exam does not rule out injuries and must be verified by a reference test such as CT. This is of particular importance in paediatric trauma, where the sensitivity of POCS is poor. Based on a small number of studies in a mixed population, POCS may have a higher sensitivity in chest injuries. This warrants larger, confirmatory trials to affirm the accuracy of POCS for diagnosing thoracic trauma.</description><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD012669.pub2</identifier><identifier>PMID: 30548249</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Abdominal Injuries ; Abdominal Injuries - diagnostic imaging ; Abdominal trauma ; Adult ; Age Factors ; Chest trauma ; Child ; Diagnosis ; Diagnostic test accuracy ; Diagnostic test accuracy reviews ; Female ; Focused Assessment with Sonography for Trauma ; Focused Assessment with Sonography for Trauma - methods ; Humans ; Male ; Medicine General & Introductory Medical Sciences ; Orthopaedics & trauma ; Point-of-Care Systems ; Reference Standards ; Sensitivity and Specificity ; Thoracic Injuries ; Thoracic Injuries - diagnostic imaging ; Wounds, Nonpenetrating ; Wounds, Nonpenetrating - diagnostic imaging</subject><ispartof>Cochrane database of systematic reviews, 2018-12, Vol.2018 (12), p.CD012669</ispartof><rights>Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4732-88d7a8179b9bda4fe18465f9302ccb1494fd9a9ab62f0543d51beb550e6f66ea3</citedby><cites>FETCH-LOGICAL-c4732-88d7a8179b9bda4fe18465f9302ccb1494fd9a9ab62f0543d51beb550e6f66ea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30548249$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stengel, Dirk</creatorcontrib><creatorcontrib>Leisterer, Johannes</creatorcontrib><creatorcontrib>Ferrada, Paula</creatorcontrib><creatorcontrib>Ekkernkamp, Axel</creatorcontrib><creatorcontrib>Mutze, Sven</creatorcontrib><creatorcontrib>Hoenning, Alexander</creatorcontrib><creatorcontrib>Stengel, Dirk</creatorcontrib><title>Point‐of‐care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Point‐of‐care sonography (POCS) has emerged as the screening modality of choice for suspected body trauma in many emergency departments worldwide. Its best known application is FAST (focused abdominal sonography for trauma). The technology is almost ubiquitously available, can be performed during resuscitation, and does not expose patients or staff to radiation. While many authors have stressed the high specificity of POCS, its sensitivity varied markedly across studies. This review aimed to compile the current best evidence about the diagnostic accuracy of POCS imaging protocols in the setting of blunt thoracoabdominal trauma.
Objectives
To determine the diagnostic accuracy of POCS for detecting and excluding free fluid, organ injuries, vascular lesions, and other injuries (e.g. pneumothorax) compared to a diagnostic reference standard (i.e. computed tomography (CT), magnetic resonance imaging (MRI), thoracoscopy or thoracotomy, laparoscopy or laparotomy, autopsy, or any combination of these) in patients with blunt trauma.
Search methods
We searched Ovid MEDLINE (1946 to July 2017) and Ovid Embase (1974 to July 2017), as well as PubMed (1947 to July 2017), employing a prospectively defined literature and data retrieval strategy. We also screened the Cochrane Library, Google Scholar, and BIOSIS for potentially relevant citations, and scanned the reference lists of full‐text papers for articles missed by the electronic search. We performed a top‐up search on 6 December 2018, and identified eight new studies which may be incorporated into the first update of this review.
Selection criteria
We assessed studies for eligibility using predefined inclusion and exclusion criteria. We included either prospective or retrospective diagnostic cohort studies that enrolled patients of any age and gender who sustained any type of blunt injury in a civilian scenario. Eligible studies had to provide sufficient information to construct a 2 x 2 table of diagnostic accuracy to allow for calculating sensitivity, specificity, and other indices of diagnostic test accuracy.
Data collection and analysis
Two review authors independently screened titles, s, and full texts of reports using a prespecified data extraction form. Methodological quality of individual studies was rated by the QUADAS‐2 instrument (the revised and updated version of the original Quality Assessment of Diagnostic Accuracy Studies list of items). We calculated sensitivity and specificity with 95% confidence intervals (CI), tabulated the pairs of sensitivity and specificity with CI, and depicted these estimates by coupled forest plots using Review Manager 5 (RevMan 5). For pooling summary estimates of sensitivity and specificity, and investigating heterogeneity across studies, we fitted a bivariate model using Stata 14.0.
Main results
We included 34 studies with 8635 participants in this review. Summary estimates of sensitivity and specificity were 0.74 (95% CI 0.65 to 0.81) and 0.96 (95% CI 0.94 to 0.98). Pooled positive and negative likelihood ratios were estimated at 18.5 (95% CI 10.8 to 40.5) and 0.27 (95% CI 0.19 to 0.37), respectively. There was substantial heterogeneity across studies, and the reported accuracy of POCS strongly depended on the population and affected body area. In children, pooled sensitivity of POCS was 0.63 (95% CI 0.46 to 0.77), as compared to 0.78 (95% CI 0.69 to 0.84) in an adult or mixed population. Associated specificity in children was 0.91 (95% CI 0.81 to 0.96) and in an adult or mixed population 0.97 (95% CI 0.96 to 0.99). For abdominal trauma, POCS had a sensitivity of 0.68 (95% CI 0.59 to 0.75) and a specificity of 0.95 (95% CI 0.92 to 0.97). For chest injuries, sensitivity and specificity were calculated at 0.96 (95% CI 0.88 to 0.99) and 0.99 (95% CI 0.97 to 1.00). If we consider the results of all 34 included studies in a virtual population of 1000 patients, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 28%, POCS would miss 73 patients with injuries and falsely suggest the presence of injuries in another 29 patients. Furthermore, in a virtual population of 1000 children, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 31%, POCS would miss 118 children with injuries and falsely suggest the presence of injuries in another 62 children.
Authors' conclusions
In patients with suspected blunt thoracoabdominal trauma, positive POCS findings are helpful for guiding treatment decisions. However, with regard to abdominal trauma, a negative POCS exam does not rule out injuries and must be verified by a reference test such as CT. This is of particular importance in paediatric trauma, where the sensitivity of POCS is poor. Based on a small number of studies in a mixed population, POCS may have a higher sensitivity in chest injuries. This warrants larger, confirmatory trials to affirm the accuracy of POCS for diagnosing thoracic trauma.</description><subject>Abdominal Injuries</subject><subject>Abdominal Injuries - diagnostic imaging</subject><subject>Abdominal trauma</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Chest trauma</subject><subject>Child</subject><subject>Diagnosis</subject><subject>Diagnostic test accuracy</subject><subject>Diagnostic test accuracy reviews</subject><subject>Female</subject><subject>Focused Assessment with Sonography for Trauma</subject><subject>Focused Assessment with Sonography for Trauma - methods</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Orthopaedics & trauma</subject><subject>Point-of-Care Systems</subject><subject>Reference Standards</subject><subject>Sensitivity and Specificity</subject><subject>Thoracic Injuries</subject><subject>Thoracic Injuries - diagnostic imaging</subject><subject>Wounds, Nonpenetrating</subject><subject>Wounds, Nonpenetrating - diagnostic imaging</subject><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFkE1O5DAQhS00iP8rIF-gG9tJnHiDBD3Dj4QEC1hbZcfuGKXtlp0M6t0cgTNyEtxqGsFs2NglvXqvqj6ETimZUkLYGS15RZuqmc5-E8o4F9PlqNgOOlgLk7Xy60u9jw5Teiak4ILVe2i_IFXZsFIcoO4hOD-8_XsNNj8aosFjP0RIwYd5hGW3wjZE3DqY-5Ccn-OhCxF0ANWGhfPQY-efx-hMygVewuCMHxJ-cUOHVT_6Aee0cQHHaNdCn8zJx3-Enq7-PM5uJnf317ezi7uJLuuCTZqmraGhtVBCtVBaQ5t8hBUFYVorWorStgIEKM5sPqJoK6qMqipiuOXcQHGEzje5mcfCtDpvE6GXy-gWEFcygJPfFe86OQ9_ZeZZ04bkAL4J0DGkFI399FIi1-zllr3csl8nsmw8_Tr507aFnRsuNw0vrjcrqYPuInjzQ-5_U94B0UmbFw</recordid><startdate>20181212</startdate><enddate>20181212</enddate><creator>Stengel, Dirk</creator><creator>Leisterer, Johannes</creator><creator>Ferrada, Paula</creator><creator>Ekkernkamp, Axel</creator><creator>Mutze, Sven</creator><creator>Hoenning, Alexander</creator><creator>Stengel, Dirk</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20181212</creationdate><title>Point‐of‐care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma</title><author>Stengel, Dirk ; Leisterer, Johannes ; Ferrada, Paula ; Ekkernkamp, Axel ; Mutze, Sven ; Hoenning, Alexander ; Stengel, Dirk</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4732-88d7a8179b9bda4fe18465f9302ccb1494fd9a9ab62f0543d51beb550e6f66ea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdominal Injuries</topic><topic>Abdominal Injuries - diagnostic imaging</topic><topic>Abdominal trauma</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Chest trauma</topic><topic>Child</topic><topic>Diagnosis</topic><topic>Diagnostic test accuracy</topic><topic>Diagnostic test accuracy reviews</topic><topic>Female</topic><topic>Focused Assessment with Sonography for Trauma</topic><topic>Focused Assessment with Sonography for Trauma - methods</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Orthopaedics & trauma</topic><topic>Point-of-Care Systems</topic><topic>Reference Standards</topic><topic>Sensitivity and Specificity</topic><topic>Thoracic Injuries</topic><topic>Thoracic Injuries - diagnostic imaging</topic><topic>Wounds, Nonpenetrating</topic><topic>Wounds, Nonpenetrating - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stengel, Dirk</creatorcontrib><creatorcontrib>Leisterer, Johannes</creatorcontrib><creatorcontrib>Ferrada, Paula</creatorcontrib><creatorcontrib>Ekkernkamp, Axel</creatorcontrib><creatorcontrib>Mutze, Sven</creatorcontrib><creatorcontrib>Hoenning, Alexander</creatorcontrib><creatorcontrib>Stengel, Dirk</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stengel, Dirk</au><au>Leisterer, Johannes</au><au>Ferrada, Paula</au><au>Ekkernkamp, Axel</au><au>Mutze, Sven</au><au>Hoenning, Alexander</au><au>Stengel, Dirk</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Point‐of‐care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2018-12-12</date><risdate>2018</risdate><volume>2018</volume><issue>12</issue><spage>CD012669</spage><pages>CD012669-</pages><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Point‐of‐care sonography (POCS) has emerged as the screening modality of choice for suspected body trauma in many emergency departments worldwide. Its best known application is FAST (focused abdominal sonography for trauma). The technology is almost ubiquitously available, can be performed during resuscitation, and does not expose patients or staff to radiation. While many authors have stressed the high specificity of POCS, its sensitivity varied markedly across studies. This review aimed to compile the current best evidence about the diagnostic accuracy of POCS imaging protocols in the setting of blunt thoracoabdominal trauma.
Objectives
To determine the diagnostic accuracy of POCS for detecting and excluding free fluid, organ injuries, vascular lesions, and other injuries (e.g. pneumothorax) compared to a diagnostic reference standard (i.e. computed tomography (CT), magnetic resonance imaging (MRI), thoracoscopy or thoracotomy, laparoscopy or laparotomy, autopsy, or any combination of these) in patients with blunt trauma.
Search methods
We searched Ovid MEDLINE (1946 to July 2017) and Ovid Embase (1974 to July 2017), as well as PubMed (1947 to July 2017), employing a prospectively defined literature and data retrieval strategy. We also screened the Cochrane Library, Google Scholar, and BIOSIS for potentially relevant citations, and scanned the reference lists of full‐text papers for articles missed by the electronic search. We performed a top‐up search on 6 December 2018, and identified eight new studies which may be incorporated into the first update of this review.
Selection criteria
We assessed studies for eligibility using predefined inclusion and exclusion criteria. We included either prospective or retrospective diagnostic cohort studies that enrolled patients of any age and gender who sustained any type of blunt injury in a civilian scenario. Eligible studies had to provide sufficient information to construct a 2 x 2 table of diagnostic accuracy to allow for calculating sensitivity, specificity, and other indices of diagnostic test accuracy.
Data collection and analysis
Two review authors independently screened titles, s, and full texts of reports using a prespecified data extraction form. Methodological quality of individual studies was rated by the QUADAS‐2 instrument (the revised and updated version of the original Quality Assessment of Diagnostic Accuracy Studies list of items). We calculated sensitivity and specificity with 95% confidence intervals (CI), tabulated the pairs of sensitivity and specificity with CI, and depicted these estimates by coupled forest plots using Review Manager 5 (RevMan 5). For pooling summary estimates of sensitivity and specificity, and investigating heterogeneity across studies, we fitted a bivariate model using Stata 14.0.
Main results
We included 34 studies with 8635 participants in this review. Summary estimates of sensitivity and specificity were 0.74 (95% CI 0.65 to 0.81) and 0.96 (95% CI 0.94 to 0.98). Pooled positive and negative likelihood ratios were estimated at 18.5 (95% CI 10.8 to 40.5) and 0.27 (95% CI 0.19 to 0.37), respectively. There was substantial heterogeneity across studies, and the reported accuracy of POCS strongly depended on the population and affected body area. In children, pooled sensitivity of POCS was 0.63 (95% CI 0.46 to 0.77), as compared to 0.78 (95% CI 0.69 to 0.84) in an adult or mixed population. Associated specificity in children was 0.91 (95% CI 0.81 to 0.96) and in an adult or mixed population 0.97 (95% CI 0.96 to 0.99). For abdominal trauma, POCS had a sensitivity of 0.68 (95% CI 0.59 to 0.75) and a specificity of 0.95 (95% CI 0.92 to 0.97). For chest injuries, sensitivity and specificity were calculated at 0.96 (95% CI 0.88 to 0.99) and 0.99 (95% CI 0.97 to 1.00). If we consider the results of all 34 included studies in a virtual population of 1000 patients, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 28%, POCS would miss 73 patients with injuries and falsely suggest the presence of injuries in another 29 patients. Furthermore, in a virtual population of 1000 children, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 31%, POCS would miss 118 children with injuries and falsely suggest the presence of injuries in another 62 children.
Authors' conclusions
In patients with suspected blunt thoracoabdominal trauma, positive POCS findings are helpful for guiding treatment decisions. However, with regard to abdominal trauma, a negative POCS exam does not rule out injuries and must be verified by a reference test such as CT. This is of particular importance in paediatric trauma, where the sensitivity of POCS is poor. Based on a small number of studies in a mixed population, POCS may have a higher sensitivity in chest injuries. This warrants larger, confirmatory trials to affirm the accuracy of POCS for diagnosing thoracic trauma.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>30548249</pmid><doi>10.1002/14651858.CD012669.pub2</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2018-12, Vol.2018 (12), p.CD012669 |
| issn | 1465-1858 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6517180 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Cochrane Library |
| subjects | Abdominal Injuries Abdominal Injuries - diagnostic imaging Abdominal trauma Adult Age Factors Chest trauma Child Diagnosis Diagnostic test accuracy Diagnostic test accuracy reviews Female Focused Assessment with Sonography for Trauma Focused Assessment with Sonography for Trauma - methods Humans Male Medicine General & Introductory Medical Sciences Orthopaedics & trauma Point-of-Care Systems Reference Standards Sensitivity and Specificity Thoracic Injuries Thoracic Injuries - diagnostic imaging Wounds, Nonpenetrating Wounds, Nonpenetrating - diagnostic imaging |
| title | Point‐of‐care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-15T02%3A50%3A21IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-wiley_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Point%E2%80%90of%E2%80%90care%20ultrasonography%20for%20diagnosing%20thoracoabdominal%20injuries%20in%20patients%20with%20blunt%20trauma&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=Stengel,%20Dirk&rft.date=2018-12-12&rft.volume=2018&rft.issue=12&rft.spage=CD012669&rft.pages=CD012669-&rft.issn=1465-1858&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD012669.pub2&rft_dat=%3Cwiley_pubme%3ECD012669.pub2%3C/wiley_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/30548249&rfr_iscdi=true |