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AJR Am J Roentgenol. 2019 Dec;213(6):1324-1330. doi: 10.2214/AJR.19.21510. Epub 2019 Aug 28.

Diagnostic Performance of CT for Occult Proximal Femoral Fractures: A Systematic Review and Meta-Analysis.

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Department of Medical Imaging, Royal Inland Hospital, 311 Columbia St, Kamloops, BC V2C 2T1, Canada.
Department of Radiology, Division of Emergency Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA.
Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, Boston, MA.


OBJECTIVE. The purpose of this study was to assess the diagnostic performance of CT for detection of occult proximal femoral fracture. MATERIALS AND METHODS. A systematic search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed for studies of the sensitivity and specificity of CT for detection of hip fracture. Two independent investigators extracted data and assessed the quality of each study using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A qualitative systematic review and quantitative meta-analysis were performed. A Bayesian bivariate random effects meta-analysis model with integrated nested Laplace approximation was used to estimate sensitivity and specificity. RESULTS. Thirteen heterogeneously reported studies were assessed that included 1248 patients (496 with a hip fracture and 752 without) with MRI or clinical follow-up as the reference standard. There were 50 false-negative examinations. The summary estimate of sensitivity was 94% and of specificity was 100%. CONCLUSION. CT can be considered a reasonable choice when occult proximal femoral fracture is suspected clinically in patients for whom MRI is contraindicated or not readily available. However, for patients with ongoing clinical concern about hip fracture despite normal CT findings, MRI should be performed.


CT; meta-analysis; occult hip fracture; sensitivity; specificity


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