The Reliability of the Pre‐hospital Physical Examination of the Pelvis: A Retrospective, Multicenter Study

Lustenberger, Thomas; Walcher, Felix; Lefering, Rolf; Schweigkofler, Uwe; Wyen, H.; Marzi, Ingo; Wutzler, Sebastian

doi:10.1007/s00268-016-3647-2

Cited by 17 publications

(26 citation statements)

References 40 publications

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“…A total of 2,644 studies were screened. Twenty studies met the eligibility criteria and were included [10][11][12][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] in the quality assessment and meta-analysis ( Fig. 1 and S- Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Physical examinations were performed by an emergency physician in a trauma bay, emergency department, or surgical department. The reference standards were x-ray [33-36, 38, 40, 44, 46, 49], unclear [11], or x-ray or CT [10, 12, 37, 39, 41-43, 45, 47, 48]. Findings were interpreted by a radiologist [33-35, 39, 41, 43, 45, 46, 49], surgeon [12,33,35,36,42], or an unreported specialist.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Findings were interpreted by a radiologist [33-35, 39, 41, 43, 45, 46, 49], surgeon [12,33,35,36,42], or an unreported specialist. [10,11,37,38,40,44,47,48] One study [48] focused on an unstable pelvic fracture. GCS: Glasgow coma scale, In-hos: In-hospital, Pre-hos: Pre-hospital, Xp: X-ray picture, CT: Computed tomography, ?…”

Section: Study Characteristicsmentioning

confidence: 99%

“…2) because of poorly described inclusion criteria, nonreproducible methodology, inappropriate patient selection, or poor exclusion criteria, such as the selective exclusion of patients who did not have a reference standard (x-ray or CT) or complete physical examination data. In two studies, [10,11] it was not clear when the physical examination was performed. For the index test, we evaluated six studies [11,37,38,45,46,48] as having high risk or high concern because the physical examination ndings were retrospectively collected or because the index test was poorly described.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

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Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

Okada

Nishioka

Ohtsuru

et al. 2020

Preprint

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Background: Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients.Methods: Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8,300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis.Results: The median prevalence of pelvic fracture was 10.5% (interquartile range: 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10%–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion: Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

Okada

Nishioka

Ohtsuru

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Pelvic binders were introduced and became a routine part of management of the severely injured (Fig. ) . During 2011 blood for transfusion pre‐hospital became available on rotatory wing platforms .…”

Section: Discussionmentioning

confidence: 99%