The 6 articles included in the review demonstrated high sensitivity, or the ability to rule out a fracture, with a range of 75% to 92% however, there was a much wider range from 18% to 94% for specificity, or the ability to rule in a fracture. In this systematic review, Mugunthan et al 4 evaluated the accuracy of tuning-fork tests in clinical practice for diagnosing fractures. However, it has been suggested that a positive tuning-fork test is demonstrated either by way of increased pain from placing the vibrating tuning fork over the fracture site or by an audible decrease in sound conduction (detected via stethoscope) when placing the vibrating tuning fork over a bony prominence distal to the fracture site and comparing it with the healthy limb. Standard practice and training in using tuning forks for clinical practice are lacking. Tuning forks may be a cost-effective screening tool for practitioners examining patients with suspected fractures. 1 The current reference standard for diagnosing fractures is magnetic resonance imaging, radiography, or bone scan. The increased costs of imaging have demonstrated a need for a cost-effective and reproducible method or tool that would aid athletic trainers in the physical examination of suspected fractures in clinical practice. Sensitivity sound transmission specificity.When performing a diagnostic test, it is important for athletic trainers to understand the diagnostic accuracy of the test to help rationalize either ruling in or ruling out a specific condition. Despite the lack of strong evidence for diagnosing all fractures, tuning-fork tests may be appropriate in rural and remote settings in which access to the gold standards for diagnosis of fractures is limited. Similarly, the tuning-fork tests were not statistically accurate in the diagnosis of fractures for widespread clinical use. However, strong evidence is lacking to support the use of current tuning-fork tests to rule in a fracture in clinical practice. The studies included in this review demonstrated that tuning-fork tests have some value in ruling out fractures. The positive likelihood ratios ranged from 1.1 to 16.5 the negative likelihood ratios ranged from 0.09 to 0.49. The specificity of the tuning-fork tests had a wide range of 18% to 94%. The sensitivity of the tuning-fork tests was high, ranging from 75% to 92%. The prevalence of fracture in these patients ranged from 10% to 80% using a reference standard such as magnetic resonance imaging, radiography, or bone scan. The patients ranged in age from 7 to 84 years. The 6 studies assessed the accuracy of 2 tuning-fork test methods (pain induction and reduction of sound transmission). Six primary studies (329 patients) were included in the review. Data for the primary outcome measure (accuracy of the test) were presented in a 2 × 2 contingency table to show sensitivity and specificity (using the Wilson score method) and positive and negative likelihood ratios with 95% confidence intervals.Ī total of 62 citations were initially identified. A third researcher was consulted if the 2 initial reviewers did not reach consensus. The QUADAS-2 is an updated version of the original QUADAS and focuses on both the risk of bias and applicability of a study through a series of questions. All relevant articles were included and assessed for inclusion criteria and value using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, and relevant data were extracted. Potentially eligible studies were independently assessed by 2 researchers. Studies were not eligible if they were case series, case-control studies, or narrative review papers. Studies included patients of all ages in all clinical settings with no exclusion for language of publication. Studies were eligible based on the following criteria: (1) primary studies that assessed the diagnostic accuracy of tuning forks (2) measured against a recognized reference standard such as magnetic resonance imaging, radiography, or bone scan and (3) the outcome was reported using pain or reduction of sound. ![]() ![]() The following key words were used independently or in combination: auscultation, barford test, exp fractures, fracture, tf test, tuning fork. In addition, they manually searched reference lists from the initial search result to identify relevant studies. The authors performed a comprehensive literature search of AMED, CAB Abstracts, CINAHL, EMBASE, MEDLINE, SPORTDiscus, and Web of Science from each database's start to November 2012. 2014 4(8):e005238.ĭoes evidence support the use of tuning-fork tests in the diagnosis of fractures in clinical practice? Is there sufficient evidence for tuning fork tests in diagnosing fractures? A systematic review. ![]() Mugunthan K, Doust J, Kurz B, Glasziou P.
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