RT Journal Article
SR Electronic
T1 Is there sufficient evidence for tuning fork tests in diagnosing fractures? A systematic review
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e005238
DO 10.1136/bmjopen-2014-005238
VO 4
IS 8
A1 Kayalvili Mugunthan
A1 Jenny Doust
A1 Bodo Kurz
A1 Paul Glasziou
YR 2014
UL http://bmjopen.bmj.com/content/4/8/e005238.abstract
AB Objective To determine the diagnostic accuracy of tuning fork tests for detecting fractures. Design Systematic review of primary studies evaluating the diagnostic accuracy of tuning fork tests for the presence of fracture. Data source We searched MEDLINE, CINAHL, AMED, EMBASE, Sports Discus, CAB Abstracts and Web of Science from commencement to November 2012. We manually searched the reference lists of any review papers and any identified relevant studies. Study selection and data extraction Two reviewers independently reviewed the list of potentially eligible studies and rated the studies for quality using the QUADAS-2 tool. Data were extracted to form 2×2 contingency tables. The primary outcome measure was the accuracy of the test as measured by its sensitivity and specificity with 95% CIs. Data synthesis We included six studies (329 patients), with two types of tuning fork tests (pain induction and loss of sound transmission). The studies included patients with an age range 7–60 years. The prevalence of fracture ranged from 10% to 80%. The sensitivity of the tuning fork tests was high, ranging from 75% to 100%. The specificity of the tests was highly heterogeneous, ranging from 18% to 95%. Conclusions Based on the studies in this review, tuning fork tests have some value in ruling out fractures, but are not sufficiently reliable or accurate for widespread clinical use. The small sample size of the studies and the observed heterogeneity make generalisable conclusion difficult.