Reporting errors in plain radiographs for lower limb trauma-a systematic review and meta-analysis

Area of Science:

• Radiology
• Orthopedic Surgery
• Diagnostic Imaging

Background:

• Plain radiographs are essential for musculoskeletal injury assessment globally.
• Inaccurate interpretation of radiographs leads to adverse patient outcomes.
• Limited meta-analytic research exists on radiograph interpretation accuracy for skeletal trauma.

Purpose of the Study:

• To systematically review and meta-analyze the diagnostic accuracy of initial radiograph reporting for lower limb skeletal trauma.
• To assess the sensitivity and specificity of radiograph interpretation for common lower limb injuries.

Main Methods:

• Systematic review and meta-analysis of published research from major clinical-science databases.
• Inclusion of studies based on eligibility criteria, followed by quality and risk of bias assessment.
• Application of HSROC and bivariate models to determine summary diagnostic accuracy rates, including anatomical site covariates.

Main Results:

• Analysis of 10 studies, selected from 3887 screened articles.
• Overall sensitivity of 93.5% and specificity of 89.7% for lower limb radiograph interpretation.
• Ankle radiograph interpretation demonstrated the highest accuracy, with 98.1% sensitivity and 94.6% specificity.

Conclusions:

• Lower limb skeletal radiograph interpretation demonstrates good sensitivity and specificity.
• A significant rate of missed fractures (1 in 20 true positives) necessitates improved safety netting.
• Virtual fracture clinics, teleradiology, and novel technologies are proposed to enhance diagnostic accuracy and patient safety.