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Multi-detector CT for suspected hip fragility fractures: A diagnostic test accuracy systematic review and meta-analysis

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Abstract

To perform a systematic review (SR) and meta-analysis to determine the diagnostic test accuracy (DTA) of Multi-Detector Computed Tomography (MDCT) for detecting proximal femoral (hip) fragility fractures in patients with a negative initial radiograph. MEDLINE and EMBASE were searched to identify relevant studies published between January 2000 and May 2018. Articles underwent title and abstract screening followed by full-text screening. Study inclusion criteria are patients with suspected hip fracture, negative initial radiograph, MDCT as the index test, magnetic resonance imaging (MRI) or clinical follow-up as the reference standard, and DTA measure as the outcome. Demographic, methodologic, and study outcome data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. DTA metrics were pooled using bivariate random-effects meta-analysis. From an initial 1385 studies, four studies reporting on 418 patients (174 with hip fractures) were included. Pooled summary statistics included the following: sensitivity (87%; 95% confidence interval [CI] 79–93), specificity (98%; 95% CI 95–99), and the area under the summary receiver operating characteristic (ROC) curve (0.972). MDCT has a high specificity for detecting hip fragility fractures, comparable to MRI, but a lower sensitivity. Local institutional factors may play a role in whether a patient receives MDCT or MRI, as imaging should not be delayed. If there is ongoing concern for fracture in a patient with a negative MDCT, MRI should be performed. Cautious interpretation of the results is warranted given the risk of bias and small sample size.

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Acknowledgments

We would like to thank Stephanie Sanger, the librarian at the McMaster Health Sciences Library, for her assistance in creating the search strategy.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton, ON, Canada

    Mostafa Alabousi

  2. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Isabelle D Gauthier, Nicole Li & Gonçalo MF dos Santos

  3. Department of Radiology, McMaster University, Juravinski Hospital, Hamilton, ON, Canada

    Dmitry Golev

  4. Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada

    Michael N Patlas

  5. Department of Radiology, McMaster University, St. Joseph’s Healthcare, Hamilton, ON, Canada

    Abdullah Alabousi

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  1. Mostafa Alabousi
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Correspondence to Abdullah Alabousi.

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Alabousi, M., Gauthier, I.D., Li, N. et al. Multi-detector CT for suspected hip fragility fractures: A diagnostic test accuracy systematic review and meta-analysis. Emerg Radiol 26, 549–556 (2019). https://doi.org/10.1007/s10140-019-01696-x

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