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Table 8 Summary of test accuracy findings in musculoskeletal ultrasound

From: Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

TestAuthor Op.YearCountry (no. of studies in MA)Train.nPrev (%)AgeCriterion standardSn. in % (95% CI)Sp. in % (95% CI)LR+ (95% CI)LR− (95% CI)
Ulnar ligamentous strain injuriesLee and Yun [188]EP2018South Korea1 week65NR31MRI97.2 (92.0–99.4)96.8 (93.5–98.7)30.4a0.03a
Oguz et al. [187]EP2017TurkeyNR801946MRI66.7 (41.7– 84.8)100 (94.4–100)a0.333a
Ankle anterior talofibular ligament strain injuryGün et al. [189]EP2013Turkey6 h.654934MRI93.8 (79.2–99.2)100 (89.4–100)0.06
Lee and Yun [190]EP2017South Korea1 week857727MRI98.5 (91.7–100)95.0 (75.1–99.9)19.7a0.0158a
Ankle calcaneofibular ligament injuryLee and Yun [190]EP2017South Korea1 week852127MRI96.4 (81.7–99.9)100 (81.5, 100)a0.0360a
Achilles tendon ruptureLee and Yun [190]EP2017South Korea1 week85827MRI100 (59.0–100)100 (95.4–100)a0a
Hip effusion (paediatric)Cruz et al. [194]EP2018USANR 9266Final diagnosis85 (79–89)98 (96–99)43a0.15a
Vieira and Levy [193]EP2010USA30 min55438Radiologist performed US80 (51–95)98 (85–99)32a (4.5–225)a0.21a (0.07–0.57)a
Extremity tendon lacerationWu et al. [191]EP2012USA2 h.3438> 16Wound exploration or MRI100 (75–100)a95 (76–100)20a0a
Mohammadrezai et al. [192]EP2017Iran6 h.603030Wound exploration94.4 (72.7–99.8)100.0 (91.5–100.0)a0.06 (0.01–0.37)
Shoulder dislocationGottlieb et al. [196]EP2019MA (7)739126035X-ray99.1 (84.9100)99.9 (88.9100)796.2 (8.079,086)0.01 (00.17)
ACL or PCL rupturesLee and Yun [197]EP2019South Korea1 week627329MRI92.2 (81.1–97.8)95.9 (88.5–99.1)22.5a0.0813a
Skull fractures (paediatric)Weinberg et al. [198]EP2010USA1 h.2110NRCT100 (20–100)100 (79–100)0
Riera and Chen [199]EP2012USANR46242CT82 (48–97)94 (79–99)14a0.085a
Parri et al. [200]EP2013Italia1 h.55643.7CT100 (88.2–100)95.0 (75.0–99.9)20a0a
Rabiner et al. [201]EP2013USA30 m.69126.4CT88 (53–98)97 (89–99)27 (7–107)0.13 (0.02–0.81)
Choi et al. [202]EP2018South Korea1 h.871521 monthsCT76.9 (46.0–93.8)100 (93.9–100)a0.231a
Parri et al. [203]EP2018ItaliaNR115848 monthsCT90.9 (82.9–96.0)85.2 (66.3–95.8)6.14a (2.48–15.2)a0.11a (0.05–0.21)a
ClavicleCross et al. [204]EP2010USANR1004311X-ray95 (83–99)96 (87–99)27 (7–106)0.05 (0.01–0.19)
Weinberg et al. [198]EP2010USA1 h.1560NRX-ray89 (51–99)83 (36–99)5.3 (0.87–32.4)0.13 (0.01–0.90)
Chien et al. [205]EP2011USA15 m.58677X-ray89.7 (75.8–97.1)89.5 (66.9–98.7)8.530.11
Elbow fractures (paediatric)Lee and Yun [206]EP2019MA (5)bNR4454469X-ray95 (87100)94 (88100)16a0.053
Forearm fractures (paediatric)Chartier et al. [208]EPc2017MA (10)NRNRNRNRX-ray93.1 (87.296.4)92.9 (86.696.4)14.1 (6.7125)0.08 (0.040.15)
Hedelin et al. [209]EP2017Sweden1.5 h.1166511X-ray97.4 (90.9–99.7)84 (67.2–94.7)6.23a (2.78–13.96)a0.03a (0.01–0.12)a
Rowlands et al. [210]EP2017Australia3.5 h.419569X-ray91.5 (87.1–94.7)a87.5 (81.9–92.0)a7.36a (5.01–10.8)a0.10a (0.06–0.15)a
Distal forearm fractures (all ages)Douma-den Hamer et al. [211]EPc2016MA (16)NR120453NRX-ray97 (9399)95 (8998)20 (8.547.2)0.03 (0.010.08)
Sivrikaya et al. [212]EP2016Turkey 93 47CT/X-ray and orthopaedic evaluation97.4 (90.2e99.5)92.6 (85.5–96.5)13.1 (6.7–25.6)0.02 (0–0.10)
Wrist fracture (any)Oguz et al. [187]EP2017TurkeyNR808046X-ray and/or CT95.31 (87.10–98.39)93.75 (71.67–98.89)15.25a (2.28–101)a0.05a (0.02–0.15)a
Metacarpal or phalangeal fracturesTayal et al. [213]EP2007USANR784034X-ray or surgical findings90 (74–97)98 (95–100)42.5 (NR)0.1 (NR)
Neri et al. [214]EPd2014Italy2 h.1533912X-ray91.5 (84.4–98.7)96.8 (93.2–100)28.7a (9.39–87.5)a0.09a (0.04–0.20)a
Metacarpal fracturesKozaci et al. [215]EP2015TurkeyNR665524X-ray (reported by EPs)92 (NR)87 (NR)7.1a0.091a
Kocaoğlu et al. [219]EP2016Turkey0964030X-ray (reported by EP)92.5 (78.5–98.0)98.3 (89.5–99.9)54.4a0.08a
Fifth metacarpal fractureAksay et al. [216]EP2015Turkey1 h.814828X-ray (reported by OS) or CT97.4 (84.9–99.9)92.9 (79.4–98.1)14 (4.58–41)0.03 (0.00–0.19)
Proximal or middle phalanx fractureAksay et al. [217]EP2016TurkeyNR1192427X-ray (reported by OS)79.3 (59.7–91.2)90 (81.4–95)7.93 (4.15–15)0.23 (0.11–0.47)
Distal phalanx fractureGungor et al. [218]EP2016Turkey3 h.452932X-ray reported by EP100 (79–100)98 (91–100)59 (8–412)0
Nail bed injuryGungor et al. [218]EP2016Turkey3 h.457332Visual inspection93 (80–99)100 (74–100)0.06 (0.02–0.23)
Tibia and/or fibula (anywhere)Kozaci et al. [220]EP2017Turkey2 h.62345–55X-ray reported by EP100 (84–100)a93 (80–98)a13.7a (4.60–40.6)a0a
Medial or lateral malleolus fractureChartier et al. [208]EPc2017MA (4)NR609a723AdultsX-ray and/or CT89.5 (77.095.6)94.2 (86.197.7)16.4 (6.5733.5)0.12 (0.050.24)
Lateral malleolusOzturk et al. [223]EP2018Turkey2 h.1203541X-ray and/or CT evaluated by OS100 (90–100)93 (85–98)8.4 (3.6–19.3)0
Malleolar fracture OR fifth metatarsal fractureTollefson et al. [222]EP2016USA1 h.503635X-ray reported by radiologist100 (78–100)100 (87–100)a0a
Navicular fractureAtilla et al. [221]EP2014Turkey4 h.341537X-ray and/or CT evaluated by OS40 (7–83)93 (76–99)5.7a0.65a
Fifth metatarsal fractureAtilla et al. [221]EP2014Turkey4 h.973037X-ray and/or CT evaluated by OS100 (85–100)96 (87–99)25a0a
Yesilaras et al. [224]EP2014Turkey0844136X-ray reported by OS97.1 (82.9–99.8)100 (91.1–100)0.03 (0.01–0.21)
Kozaci et al. [225]EP2017Turkey2 h.72395–55X-ray reported by EP93 (77–99)a89 (75–96)a8.17a (3.56–18.7)a0.08a (0.02–0.31)a
  1. MA, meta-analysis (shown in italics with number of studies in brackets); Op., operators; Train., time spent in didactic intervention; m., minutes; h., hours; n, size of population; Prev., prevalence; Age, median- or mean age; Sn., sensitivity; Sp., specificity; CI, confidence interval; LR+, positive likelihood ratio; LR−, negative likelihood ratio; EP, emergency physician; NR, not reported; CT, computed tomography; MRI, magnetic resonance imaging; US, ultrasound; OS, orthopaedic surgeon
  2. aCalculated by the authors from available data
  3. bEP sub-group analyzed separately
  4. cThe majority of studies included involved EPs