Ratio class | Ratio name | Notation | Formula |
Profitability ratios | Return on assets | ROA | Net income/average assets |
| Return on shareholder equity | ROSE | Net income/average stockholder equity |
| Profit margin | PM | Net income/revenue |
Liquidity ratios | Current ratio | CR | Current assets/current liabilities |
| Networking capital ratio | WCR | Current assets – current liabilities/total assets |
Management efficiency ratios | Total assets turnover | TAT | Revenue/total assets |
| Revenue per worker wage | R/W | Revenue/salary expense |
| Revenue per fixed asset | R/FA | Revenue/fixed assets |
| Working capital turnover | WCT | Current assets – current liabilities/revenue |
Leverage ratios | Debt ratio | DR | Long term liabilities/total assets |
| Equity ratio | ER | Shareholder’s equity/total assets |
| Debt equity ratio | DER | Total long term debts/shareholder’s capital |
| Times interest cover | TI | Income before interest and tax/interest expense |
Valuation and growth | Earnings per share | EPS | Net profit/average number of shares |
| Customers revenue | R/C | Revenue/number of subscribers |
| Customer growth | CG | Yearly change in customers/customer in base year |
Cash flow indicator | Cash flow indicator | OC/S | Operating cash/sales |
Tax | Effective tax rate | ETxR | Tax/income before tax |
Descriptive statistics for telecoms industry
| | Minimum | Maximum | Mean | SD | Variance |
ROA | 17 | 0.034 | 0.155 | 0.07047 | 0.028777 | 0.001 |
ROSE | 17 | 0.044 | 0.227 | 0.09906 | 0.044561 | 0.002 |
PM | 17 | 0.071 | 0.197 | 0.12612 | 0.038696 | 0.001 |
CR | 17 | 0.475 | 1.461 | 0.71694 | 0.300431 | 0.090 |
WCR | 17 | −0.255 | 0.044 | −0.14247 | 0.090237 | 0.008 |
TAT | 17 | 0.366 | 0.563 | 0.49141 | 0.044887 | 0.002 |
R/W | 17 | 7.060 | 14.586 | 11.23800 | 2.411187 | 5.814 |
R/FA | 17 | 0.438 | 0.725 | 0.62741 | 0.075328 | 0.006 |
WCT | 17 | −19.003 | 7.642 | −0.50535 | 6.929393 | 48.016 |
DR | 17 | 0.369 | 0.504 | 0.44800 | 0.039541 | 0.002 |
ER | 17 | 0.457 | 0.585 | 0.53306 | 0.038073 | 0.001 |
DER | 17 | 0.738 | 1.123 | 0.90176 | 0.128357 | 0.016 |
TI | 17 | 13.193 | 193.340 | 68.81465 | 58.139654 | 3,380.219 |
EPS | 17 | 0.655 | 2.353 | 1.68376 | 0.602397 | 0.363 |
R/C | 17 | 77.940 | 120.250 | 98.09888 | 14.579564 | 212.564 |
CG | 17 | 0.035 | 1.000 | 0.18359 | 0.234845 | 0.055 |
OC/S | 17 | 0.299 | 0.497 | 0.38606 | 0.063964 | 0.004 |
ETxR | 17 | 0.215 | 0.595 | 0.28076 | 0.085013 | 0.007 |
Valid (listwise) | 17 | | | | | |
Inter-item correlation matrix for China telecoms Industry
| ROA | ROSE | PM | CR | WCR | TAT | R/W | R/FA | WCT | DR | ER | DER | TI | EPS | R/C | CG | OC/S | ETxR |
ROA | 1.000 | 0.992 | 0.840 | 0.454 | 0.653 | −0.135 | 0.670 | −0.358 | 0.054 | −0.338 | 0.244 | −0.443 | −0.658 | −0.488 | −0.228 | 0.836 | 0.835 | 0.138 |
ROSE | 0.992 | 1.000 | 0.824 | 0.416 | 0.606 | −0.085 | 0.632 | −0.324 | 0.064 | −0.322 | 0.261 | −0.437 | −0.650 | −0.435 | −0.199 | 0.798 | 0.812 | 0.209 |
PM | 0.840 | 0.824 | 1.000 | 0.396 | 0.655 | −0.493 | 0.770 | −0.474 | −0.158 | −0.395 | 0.162 | −0.432 | −0.817 | −0.565 | −0.644 | 0.617 | 0.902 | 0.272 |
CR | 0.454 | 0.416 | 0.396 | 1.000 | 0.927 | −0.343 | 0.427 | 0.105 | 0.350 | −0.738 | −0.436 | −0.339 | −0.395 | −0.397 | −0.340 | 0.329 | 0.573 | 0.032 |
WCR | 0.653 | 0.606 | 0.655 | 0.927 | 1.000 | −0.462 | 0.640 | −0.142 | 0.235 | −0.726 | −0.269 | −0.437 | −0.604 | −0.591 | −0.494 | 0.520 | 0.797 | 0.040 |
TAT | −0.135 | −0.085 | −0.493 | −0.343 | −0.462 | 1.000 | −0.262 | 0.632 | 0.281 | 0.219 | 0.305 | 0.042 | 0.413 | 0.589 | 0.555 | −0.229 | −0.528 | −0.068 |
R/W | 0.670 | 0.632 | 0.770 | 0.427 | 0.640 | −0.262 | 1.000 | −0.324 | −0.127 | −0.217 | −0.156 | −0.089 | −0.762 | −0.654 | −0.635 | 0.536 | 0.766 | −0.013 |
R/FA | −0.358 | −0.324 | −0.474 | 0.105 | −0.142 | 0.632 | −0.324 | 1.000 | 0.509 | −0.388 | 0.080 | −0.275 | 0.373 | 0.752 | 0.083 | −0.657 | −0.470 | 0.150 |
WCT | 0.054 | 0.064 | −0.158 | 0.350 | 0.235 | 0.281 | −0.127 | 0.509 | 1.000 | −0.481 | 0.089 | −0.420 | 0.287 | 0.226 | 0.121 | −0.078 | −0.057 | 0.025 |
DR | −0.338 | −0.322 | −0.395 | −0.738 | −0.726 | 0.219 | −0.217 | −0.388 | −0.481 | 1.000 | −0.115 | 0.826 | 0.299 | −0.054 | 0.505 | 0.013 | −0.444 | −0.324 |
ER | 0.244 | 0.261 | 0.162 | −0.436 | −0.269 | 0.305 | −0.156 | 0.080 | 0.089 | −0.115 | 1.000 | −0.640 | 0.107 | 0.459 | 0.069 | 0.072 | −0.033 | 0.234 |
DER | −0.443 | −0.437 | −0.432 | −0.339 | −0.437 | 0.042 | −0.089 | −0.275 | −0.420 | 0.826 | −0.640 | 1.000 | 0.191 | −0.229 | 0.330 | −0.103 | −0.368 | −0.351 |
TI | −0.658 | −0.650 | −0.817 | −0.395 | −0.604 | 0.413 | −0.762 | 0.373 | 0.287 | 0.299 | 0.107 | 0.191 | 1.000 | 0.571 | 0.676 | −0.417 | −0.867 | −0.151 |
EPS | −0.488 | −0.435 | −0.565 | −0.397 | −0.591 | 0.589 | −0.654 | 0.752 | 0.226 | −0.054 | 0.459 | −0.229 | 0.571 | 1.000 | 0.279 | −0.687 | −0.691 | 0.290 |
R/C | −0.228 | −0.199 | −0.644 | −0.340 | −0.494 | 0.555 | −0.635 | 0.083 | 0.121 | 0.505 | 0.069 | 0.330 | 0.676 | 0.279 | 1.000 | 0.077 | −0.581 | −0.293 |
CG | 0.836 | 0.798 | 0.617 | 0.329 | 0.520 | −0.229 | 0.536 | −0.657 | −0.078 | 0.013 | 0.072 | −0.103 | −0.417 | −0.687 | 0.077 | 1.000 | 0.653 | −0.164 |
OC/S | 0.835 | 0.812 | 0.902 | 0.573 | 0.797 | −0.528 | 0.766 | −0.470 | −0.057 | −0.444 | −0.033 | −0.368 | −0.867 | −0.691 | −0.581 | 0.653 | 1.000 | 0.120 |
ETxR | 0.138 | 0.209 | 0.272 | 0.032 | 0.040 | −0.068 | −0.013 | 0.150 | 0.025 | −0.324 | 0.234 | −0.351 | −0.151 | 0.290 | −0.293 | −0.164 | 0.120 | 1.000 |
Total variance explained
| Initial eigenvalues | Extraction sums of squared loadings |
Component | Total | % of variance | Cumulative % | Total | % of variance | Cumulative % |
1 | 7.982 | 44.344 | 44.344 | 7.982 | 44.344 | 44.344 |
2 | 3.430 | 19.056 | 63.400 | 3.430 | 19.056 | 63.400 |
3 | 2.217 | 12.315 | 75.715 | 2.217 | 12.315 | 75.715 |
4 | 1.779 | 9.883 | 85.598 | 1.779 | 9.883 | 85.598 |
5 | 0.967 | 5.370 | 90.968 | | | |
6 | 0.719 | 3.997 | 94.965 | | | |
7 | 0.432 | 2.401 | 97.365 | | | |
8 | 0.234 | 1.298 | 98.663 | | | |
9 | 0.108 | 0.602 | 99.266 | | | |
10 | 0.059 | 0.327 | 99.592 | | | |
11 | 0.038 | 0.212 | 99.805 | | | |
12 | 0.016 | 0.088 | 99.893 | | | |
13 | 0.012 | 0.067 | 99.960 | | | |
14 | 0.005 | 0.028 | 99.988 | | | |
15 | 0.001 | 0.008 | 99.996 | | | |
16 | 0.001 | 0.004 | 100.000 | | | |
17 | 1.001E-016 | 5.560E-016 | 100.000 | | | |
18 | −1.876E-016 | −1.042E-015 | 100.000 | | | |
Extraction method: principal component analysis | Component |
| 1 | 2 | 3 | 4 |
-score: ROA | | 0.091 | 0.428 | 0.216 |
-score: ROSE | | 0.118 | 0.464 | 0.192 |
-score: PM | | 0.011 | 0.199 | −0.240 |
-score: CR | | 0.320 | −0.530 | 0.374 |
-score: WCR | | 0.224 | −0.352 | 0.252 |
-score: TAT | −0.528 | 0.308 | 0.408 | 0.355 |
-score: R/W | | −0.154 | −0.042 | −0.032 |
-score: R/FA | −0.456 | 0.751 | −0.222 | 0.101 |
-score: WCT | −0.041 | | −0.129 | |
Z-score: DR | −0.488 | −0.786 | 0.310 | 0.014 |
-score: ER | −0.052 | 0.434 | | −0.232 |
-score: DER | −0.391 | −0.809 | −0.227 | 0.103 |
-score: TI | −0.836 | 0.115 | 0.029 | 0.279 |
-score: EPS | −0.705 | | 0.188 | −0.200 |
-score: R/C | −0.594 | −0.159 | 0.366 | |
-score: CG | | −0.309 | 0.409 | 0.433 |
-score: OC/S | | −0.026 | 0.023 | −0.039 |
-score: ETxR | 0.134 | 0.436 | 0.131 | −0.538 |
Extraction method: principal component analysis. Ratios extracted from the components are in italic based on significant level above 0.5. Four components extracted Ratio name | Notation | Ratio name | Notation |
Return on assets | ROA | Working capital turnover | WCT |
Return on shareholder equity | ROSE | Equity ratio | ER |
Profit margin | PM | Earnings per share | EPS |
Current ratio | CR | Customers revenue | R/C |
Networking capital ratio | WCR | Customer growth | CG |
Revenue per worker wage | R/W | Cash flow indicator | OC/S |
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An umbrella review and updated meta-analysis of imaging modalities in occult scaphoid and hip and femoral fractures.
1. Introduction
2. materials and methods, 2.1. search strategy and study selection, 2.2. eligibility criteria, 2.3. inclusion and exclusion criteria, 2.4. data extraction and quality assessment, 2.5. stratification of evidence, 2.6. data synthesis, 4. discussion, 5. conclusions, supplementary materials, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.
Study | Risk of Bias | Applicability Concerns | Conclusions |
---|
Patient Selection | Index Test | Reference Standard | Flow and Timing | Patient Selection | Index Test | Reference Standard |
---|
Yildirim (2013) [ ] | ☺ | ☺ | ? | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Platon (2011) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Fusetti (2005) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Senall (2004) [ ] | ☺ | ☺ | ☹ | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Hauger (2002) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Herneth (2001) [ ] | ☺ | ? | ? | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Xie (2020) [ ] | ☹ | ? | ☺ | ☺ | ? | ? | ☺ | At risk of bias |
Kitsis (1989) [ ] | ☹ | ? | ? | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Thorpe (1996) [ ] | ☺ | ? | ? | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Fowler (1998) [ ] | ☺ | ? | ☺ | ☺ | ☺ | ? | ☺ | At risk of bias |
Borel (2017) [ ] | ☺ | ? | ☺ | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Edlund (2016) [ ] | ☺ | ☺ | ☺ | ☹ | ☺ | ☺ | ☺ | At risk of bias |
De Zwart (2012) [ ] | ? | ☹ | ☹ | ☺ | ☺ | ☹ | ☺ | At risk of bias |
Beeres (2008) [ ] | ☺ | ☹ | ☹ | ☺ | ☺ | ☹ | ☺ | At risk of bias |
Ilica (2011) [ ] | ☹ | ☺ | ☺ | ☹ | ☺ | ☺ | ☺ | At risk of bias |
Mallee (2011) [ ] | ☺ | ? | ☺ | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Memasadeghi (2006) [ ] | ? | ☺ | ? | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Breitenseher (1997) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Tiel-van Buul (1996) [ ] | ? | ? | ? | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Nielsen (1983) [ ] | ? | ? | ? | ☺ | ☺ | ☺ | ☺ | At risk of bias |
O’Carroll (1982) [ ] | ☹ | ☹ | ☹ | ☹ | ☹ | ☹ | ☹ | At risk of bias |
Stordahl (1984) [ ] | ? | ☺ | ? | ? | ? | ☺ | ? | At risk of bias |
Tiel-van Buul (1993) [ ] | ☺ | ☺ | ? | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Study | Risk of Bias | Applicability Concerns | Conclusions |
---|
Patient Selection | Index Test | Reference Standard | Flow and Timing | Patient Selection | Index Test | Reference Standard |
---|
Deutsch (1989) [ ] | ☹ | ☹ | ? | ☺ | ? | ? | ? | At risk of bias |
Rizzo (1993) [ ] | ☹ | ☹ | ? | ☺ | ? | ? | ? | At risk of bias |
Quinn and McCarthy (1993) [ ] | ☺ | ☹ | ☹ | ☺ | ☺ | ☹ | ☺ | At risk of bias |
Evans (1994) [ ] | ☺ | ☹ | ? | ☺ | ? | ? | ? | At risk of bias |
Haramati (1994) [ ] | ☹ | ☹ | ☹ | ☹ | ☹ | ☹ | ☹ | At risk of bias |
Bogost (1995) [ ] | ? | ☹ | ☹ | ☺ | ? | ☺ | ☺ | At risk of bias |
Stiris and Lilleas (1997) [ ] | ? | ☹ | ☹ | ☺ | ? | ☺ | ☺ | At risk of bias |
Rubin (1998) [ ] | ? | ? | ? | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Pandey (1998) [ ] | ☹ | ☹ | ☹ | ☹ | ☹ | ☹ | ☹ | At risk of bias |
Lim (2002) [ ] | ☺ | ☹ | ☹ | ☺ | ☺ | ☹ | ☹ | At risk of bias |
Oka and Monu (2004) [ ] | ☺ | ☹ | ☹ | ☺ | ☺ | ☹ | ☹ | At risk of bias |
Galloway (2004) [ ] | ☹ | ? | ☺ | ? | ☺ | ☺ | ☺ | At risk of bias |
Lee (2004) [ ] | ☹ | ? | ☺ | ? | ☺ | ☺ | ☺ | At risk of bias |
Alam (2005) [ ] | ☺ | ? | ☺ | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Frihagen (2005) [ ] | ☺ | ☹ | ☹ | ☺ | ☺ | ☹ | ☹ | At risk of bias |
Verbeeten (2005) [ ] | ☺ | ? | ☺ | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Lubovsky (2005) [ ] | ☹ | ? | ☺ | ☹ | ☹ | ? | ☺ | At risk of bias |
Dominguez (2005) [ ] | ☹ | ? | ☺ | ☺ | ? | ☺ | ☺ | At risk of bias |
Chana (2006) [ ] | ? | ☹ | ☺ | ? | ☺ | ☺ | ? | At risk of bias |
Hossain (2007) [ ] | ? | ? | ☺ | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Sankey (2009) [ ] | ☺ | ☹ | ☺ | ☺ | ☺ | ☺ | ☺ | At risk of bias |
Safran (2009) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Szewczyk (2012) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Iwata (2012) [ ] | ☺ | ? | ☺ | ☺ | ☺ | ? | ☺ | At risk of bias |
Dunker (2012) [ ] | ☺ | ☺ | ☹ | ☺ | ☺ | ☺ | ☹ | At risk of bias |
Ohishi (2012) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Geijer (2012) [ ] | ☺ | ☺ | ☹ | ? | ☺ | ☺ | ☹ | At risk of bias |
Gill (2013) [ ] | ☹ | ☺ | ☹ | ? | ☹ | ? | ☹ | At risk of bias |
Heikal (2014) [ ] | ☺ | ☺ | ☹ | ☹ | ☺ | ☺ | ☹ | At risk of bias |
Haubro (2015) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Deleanu (2015) [ ] | ☺ | ? | ☹ | ☹ | ☹ | ? | ☹ | At risk of bias |
Collin (2016) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Rehman (2016) [ ] | ☺ | ? | ☹ | ? | ☺ | ? | ☹ | At risk of bias |
Sadozai (2016) [ ] | ☺ | ☺ | ☹ | ? | ☺ | ☺ | ☹ | At risk of bias |
Thomas (2016) [ ] | ☹ | ☺ | ☹ | ? | ☺ | ☺ | ☹ | At risk of bias |
Lakshmanan (2017) [ ] | ☺ | ? | ☺ | ☺ | ☺ | ? | ☺ | At risk of bias |
Lord (2017) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Mandell (2018) [ ] | ☺ | ☺ | ☹ | ☺ | ☺ | ☺ | ☹ | At risk of bias |
Ross (2019) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Heynen (2019) [ ] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | Low risk of bias |
Haims (2020) [ ] | ☹ | ? | ? | ☺ | ☹ | ? | ☺ | At risk of bias |
Lanotte (2019) [ ] | ☹ | ☺ | ? | ☹ | ☹ | ☺ | ☺ | At risk of bias |
Kutaiba (2020) [ ] | ☹ | ☺ | ☺ | ? | ? | ? | ☺ | At risk of bias |
Tsukamoto (2023) [ ] | ☹ | ☹ | ? | ? | ? | ? | ? | At risk of bias |
Reddy (2015) [ ] | ☹ | ☺ | ☹ | ? | ☹ | ? | ☹ | At risk of bias |
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Click here to enlarge figure
Author (Year) | Objectives | Anatomy | Setting and Context | Number of Databases Sourced and Searched | Date Range of Database Searching | Publication Date Range of Studies Included in the Review that Inform Each Outcome of Interest | Number of Studies | Types of Studies | Total Number of Patients | Country of Origin of Studies | Instruments Used to Appraise the Primary Studies | AMSTAR | Relevant Outcomes Reported | Methods of Synthesis | Publication Bias | Heterogeneity | Risk of Bias |
---|
Chatha (2011) [ ] | To determine the role of CT and MRI in diagnosing occult fracture | Femur | N/A | 5 (MEDLINE, EMBASE, CINAHL, Google Scholar, and the Cochrane Library) | 31 October 2009 | 1989 to 2009 | 22 | 15 prospective and 7 retrospective | 996 | N/A | None | Critically low | MRI was an investigation of choice for occult proximal femoral fractures. | Qualitative | N/A | N/A | N/A |
Kellock (2019) [ ] | The diagnostic performance of CT for the detection of occult proximal femoral fracture | Femur | N/A | 3 (Pubmed, Embase, and Web of Science) | 1 December 2018 | 2005 to 2018 | 13 | 1 prospective, the rest are retrospective | 1248 | 5 UK, 1 USA, 1 Israel, 3 Sweden, 1 Romania, 1 Denmark, 1 Canada | QUADAS-2 | High Quality | The estimated summary sensitivity of CT for the detection of nondisplaced hip fracture was 94% (95% credible interval, 83–99%), and the specificity was 100% (95% credible interval, 99–100%) with an AUC of 0.981. | Meta-analysis | Present | Present | High risk of bias in the reference standard, with no single study achieving a good quality |
Wilson (2019) [ ] | Evaluate the diagnostic accuracy of limited MRI protocols for detecting radiographically occult proximal femoral fractures | Femur | All single-centre, academic hospitals | 4 (MEDLINE, Embase, Cochrane Library and Scopus) | 15 November 2019 | 1993–2019 (2012 to 2019 for meta-analysis; 1993 to 2016 for systematic review) | 11 (only five for meta-analysis) | 5 Prospective, 6 Retrospective (1 prospective and 4 retrospective for meta-analysis; 4 prospective and 2 retrospective for systematic review) | 938 | N/A | QUADAS-2 | High Quality | The pooled and weighted summary sensitivity and specificity and the area under the summary ROC curve for limited MRI protocols in detecting radiographically occult hip fractures were 99% (95% CI, 91–100%), 99% (95% CI, 97–100%), and 100% (95% CI, 0.99–1), respectively. | Qualitative and Meta-Analysis | N/A | N/A | All studies included in the meta-analysis were low-risk |
Haj-Mirzaian (2020) [ ] | Determine the diagnostic performance of CT and bone scanning in the detection of occult fractures using MRI as the reference standard | Femoral head, femoral neck, intertrochanteric, or subtrochanteric fractures | N/A | 3 (Pubmed, EMBASE, and Cochrane Library) | 27 September 2018 | 1993 to 2018 | 35 | N/A | 2992 | N/A | ROB | High Quality | CT and bone scanning yielded comparable diagnostic performance in the detection of radiographically occult hip fracture (p = 0.67) with a sensitivity of 79% and 87%, respectively. | Meta-analysis | Present | Present | Low ROB = 27, Moderate ROB = 6, High ROB = 2 |
Mallee (2015) [ ] | identify the most suitable diagnostic imaging strategy for identifying clinically suspected fractures of the scaphoid bone in patients with normal radiographs | Scaphoid | People of all ages who presented at the hospital or clinics within one week of trauma with a clinically suspected scaphoid fracture and negative post-trauma radiographs | 10 (Cochrane Register of Diagnostic Test Accuracy Studies, MEDLINE, EMBASE, the Database of Abstracts of Reviews of EHects, the Cochrane Central Register of Controlled Trials, the NHS Economic Evaluation Database, MEDION, ARIF, Current Controlled Trials, the World Health Organization (WHO) International Clinical Trials Registry Platform) | July 2012 | 1983–2011 | 11 | 9 Prospective, 3 Not Reported | 1041 | 5 Netherlands, 2 Austria, 1 Turkey, 1 Denmark, 1 Ireland, 1 Norway | Not Specified | High Quality | Summary sensitivity and specificity of CT were 0.72 (95% confidence interval (CI) 0.36 to 0.92) and 0.99 (95% CI 0.71 to 1.00); for MRI, these were 0.88 (95% CI 0.64 to 0.97) and 1.00 (95% CI 0.38 to 1.00); for BS, these were 0.99 (95% CI 0.69 to 1.00) and 0.86 (95% CI 0.73 to 0.94). Indirect comparisons suggest that the diagnostic accuracy of BS was significantly higher than CT and MRI, and CT and MRI have comparable diagnostic accuracy. | Meta-analysis | Present | Could not be investigated formally | Five studies were considered “good quality”, and six studies had “moderate quality”. |
Kwee (2018) [ ] | To systematically review the literature on the performance of ultrasound in diagnosing radiographically occult scaphoid fracture. | Scaphoid | N/A | 2 (MEDLINE and Embase databases) | No Limit–8 January 2018 | 2001–2013 | 7 | Not Specified | 314 | 1 Turkey, 2 Switzerland, 1 USA, 1 France, 1 Austria, 1 UK | QUADAS-2 | Critically low | The sensitivity and specificity of ultrasound in diagnosing radiographically occult scaphoid fracture ranged from 77.8% to 100% and from 71.4% to 100% respectively, with pooled estimates of 85.6% (95% CI: 73.9%, 92.6%) and 83.3% (95% CI: 72.0%, 90.6%), respectively. | Meta-analysis | Not Assessed | Cannot be explored | Index Test: Low ROB: 6, High ROB: 1; Reference Standard: High ROB: 2, Unclear: 2; Low ROB: 3; Patient Selection and Flow and Timing: Low ROB 7. |
Parameter | Scaphoid | Hip and Femur |
---|
Ultrasound | CT Scan | MRI | Bone Scan | CT Scan | MRI |
---|
No. of studies | 6 | 5 | 8 | 7 | 15 | 29 |
No. of patients | 270 | 297 | 345 | 586 | 1329 | 1905 |
Sensitivity (%) | 96 (66–100) | 81 (64–91) | 86 (68–94) | 98 (90–100) | 94 (80–99) | 98 (97–99) |
Specificity (%) | 94 (66–99) | 98 (86–100) | 98 (28–100) | 80 (44–95) | 99 (96–100) | 99 (98–99) |
Positive likelihood ratio | 16 (2.2–114.4) | 41.7 (5.5–316.6) | 48.7 (0.4–6437.6) | 4.9 (1.3–17.9) | 82.1 (22.6–298.5) | 69 (41–116.1) |
Posterior probability (%) assuming a 25% prior probability | 84 | 93 | 95 | 62 | 96 | 96 |
Negative likelihood ratio | 0.04 (0–0.47) | 0.2 (0.1–0.39) | 0.15 (0.06–0.35) | 0.02 (0–0.16) | 0.06 (0.01–0.22) | 0.02 (0.01–0.03) |
Posterior probability (%) assuming a 25% prior probability | 1 | 6 | 0.15 | 1 | 2 | 1 |
Positive predictive value | 0.95 (0.9–1) | 0.82 (0.8–0.84) | 0.86 (0.84–0.88) | 0.97 (0.85–1) | 82.1 (22.6–298.5) | 69 (41–116.1) |
Negative predictive value | 0.93 (0.88–0.99) | 0.97 (0.95–1) | 0.98 (0.95–1) | 0.81 (0.7–0.92) | 0.06 (0.01–0.22) | 0.02 (0.01–0.03) |
Diagnostic odds ratio | 387 (17–8879) | 210 (31–1449) | 334 (2–49,601) | 213 (12–3743) | 1425 (171–11851) | 4185 (2009–8720) |
Area under the curve | 0.99 (0.2–1) | 0.91 (0.17–1) | 0.91 (0.89–0.94) | 0.99 (0.97–0.99) | 1 (0.99–1) | 1 (0.99–1) |
I (%) and p-value | 81 (59–100) and 0.003 | 85 (70–100) and 0.001 | 96 (93–99) and <0.0001 | 1 (0–100) and 0.182 | 92 (83–100) and <0.0001 | 100 (0–100) and 0.5 |
Publication bias | 0.56 | 0.03 | 0.07 | 0.13 | <0.001 | <0.001 |
Likelihood ratio scattergram | LUQ; Exclusion and confirmation | RUQ; Confirmation only | RUQ; Confirmation only | RLQ; No exclusion or confirmation | LUQ; Exclusion and confirmation | LUQ; Exclusion and confirmation |
Stratification of evidence | Weak | Weak | Weak | Weak | Suggestive | Suggestive |
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Jorisal, P.; Sulay, C.B.H.; Octavius, G.S. An Umbrella Review and Updated Meta-Analysis of Imaging Modalities in Occult Scaphoid and Hip and Femoral Fractures. J. Clin. Med. 2024 , 13 , 3769. https://doi.org/10.3390/jcm13133769
Jorisal P, Sulay CBH, Octavius GS. An Umbrella Review and Updated Meta-Analysis of Imaging Modalities in Occult Scaphoid and Hip and Femoral Fractures. Journal of Clinical Medicine . 2024; 13(13):3769. https://doi.org/10.3390/jcm13133769
Jorisal, Patricia, Callistus Bruce Henfry Sulay, and Gilbert Sterling Octavius. 2024. "An Umbrella Review and Updated Meta-Analysis of Imaging Modalities in Occult Scaphoid and Hip and Femoral Fractures" Journal of Clinical Medicine 13, no. 13: 3769. https://doi.org/10.3390/jcm13133769
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