Diagnostic utility of ultrasound in pediatric nasal bone fractures: a systematic review and meta-analysis

Abstract

Ultrasonography, a radiation-free and cost-effective modality, stands out as a promising tool for evaluating nasal bone fractures. Despite limited literature on its pediatric application, there is an increasing recognition of its potential to enhance diagnostic precision. To evaluate the diagnostic efficacy of ultrasound in detecting pediatric nasal bone fractures. Employing established guidelines, a systematic review and meta-analysis were conducted through a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases until December 5, 2023. Inclusion criteria encompassed studies reporting diagnostic accuracy measures of ultrasound in pediatric patients with nasal bone fractures. Data extraction and analysis were undertaken for the selected studies. Involving four studies with 277 patients, ultrasound demonstrated a pooled sensitivity of 66.1% (95% CI: 35.1-87.5%) and specificity of 86.8% (95% CI: 80.1-91.4%) in diagnosing pediatric nasal fractures. The area under the receiver operating characteristic curve (AUC) was 0.88 (95% CI: 0.72-0.93). After excluding an outlier study, sensitivity and specificity increased to 78.0% (95% CI: 65.6-86.9%) and 87.8 (95% CI: 78.1-93.6%), respectively, with an AUC of 0.79 (95% CI: 0.75-0.94). Pooled positive and negative likelihood ratios were 5.11 (95% CI: 2.12-9.15) and 0.40 (95% CI: 0.14-0.77) before exclusion and 6.75 (95% CI: 3.47-12.30) and 0.26 (95% CI: 0.15-0.40) after exclusion of an outlier study, respectively. This study highlighted ultrasonography's utility in diagnosing pediatric nasal bone fractures with high accuracy and specificity. However, caution is advised in relying solely on ultrasound due to suboptimal overall diagnostic performance, evident in likelihood ratios.

Keywords: Fractures; Nasal bone; Pediatrics; Ultrasonography.

Fig. 1

PRISMA flow diagram showing the review process. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Fig. 2

Forest plot and summary statistics of the diagnostic test accuracy (DTA) meta-analysis incorporating all included studies. CI. Confidence interval, EP. Emergency practitioner

Fig. 3

Summary receiver operating characteristic curve (SROC) for the diagnostic test accuracy (DTA) meta-analysis encompassing all included studies. AUC. Area under the curve. SROC. Summary receiver operating characteristic

Fig. 4

Likelihood ratio scattergram of included studies indicating low to moderate test performance suboptimal for both exclusion and confirmation purposes. LLQ. Left lower quadrant. LRN. Likelihood ratio, negative. LRP. Likelihood ratio, positive. LUQ. Left upper quadrant. RLQ. Right lower quadrant. RUQ. Right upper quadrant

Fig. 5

Fagan plot analysis utilizing summary positive and negative likelihood ratio results from the meta-analysis of all included studies, considering hypothetical pre-test probabilities of 25%, 50%, and 75%. PLR. Positive likelihood ratio. NLR. Negative likelihood ratio. Neg. Negative. Pos. Positive