Purpose: To perform a diagnostic test accuracy (DTA) systematic review (SR) and meta-analysis to determine the DTA of multidetector computed tomography (MDCT) for detecting occult hip fractures in patients with a negative initial radiograph.

Methods: MEDLINE and EMBASE were searched to identify relevant studies published between January 2000-May 2018. Articles underwent title and abstract screening followed by full-text screening. Study inclusion criteria: 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 was 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. 

Results: From an initial 1385 studies, four studies reporting on 418 patients (174 with hip fractures), were included. Study demographic and risk of bias data was listed in Table 1. 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). 

Conclusions: Our pooled DTA findings suggest that MDCT may serve as a suitable second-line modality for occult hip fractures, given its widespread availability, lower cost, and shorter scan time compared to MRI. Cautious interpretation of the results is warranted given the risk of bias and small sample size. Larger validation and direct comparison studies of MDCT and MRI may help guide future appropriateness guidelines.

Multidetector CT for Suspected Hip Fractures: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis