Diagnostic Performance of Plain Film, Ultrasonography, and Computed Tomography in Nasal Bone Fractures: A Systematic Review

Purpose: The aim of this study was to compare the diagnostic performance (accuracy, sensitivity, specificity, positive predictive value, and negative predictive value) of plain film (PF), ultrasonography (USG), and computed tomography (CT) in diagnosing nasal bone fractures (NBFs). Methods: In a search of PubMed and Scopus, "nasal bone fracture" AND "X-ray OR CT OR USG OR MRI" were searched. Among the 369 titles from PubMed and 379 titles from Scopus, 257 duplicate titles were excluded and 491 titles were reviewed. Among them, 36 full articles were reviewed. From these, 21 were excluded and 1 mined article was added; thus, 16 articles were reviewed. Results: The accuracy of CT (94.4% +/- 2.3%) was significantly higher (P < .001) than that of USG (85.0% +/- 3.6%). The accuracy of USG was significantly higher (P < .001) than that of PF (67.7% +/- 4.7%). Computed tomography (89.3% +/- 3.1%) and USG (87.2% +/- 3.3%) were significantly more sensitive than PF (P < .001 and P < .001, respectively). The specificity of CT (94.2% +/- 2.3%) was significantly higher (P = .001) than that of USG (87.4% +/- 3.3%). The specificity of USG was significantly higher (P < .001) than that of PF (67.8% +/- 4.7%). Among the PF techniques, combining a lateral view and the Water's view (71.8% +/- 4.5%) had significantly higher accuracy than a lateral view alone (62.4% +/- 4.8%) or the Water's view alone (61.0% +/- 4.9%). In USG, there was no significant difference (P = .300) in accuracy among lateral and dorsal views (95.8% +/- 2.0%), a lateral view alone (84.2% +/- 3.7%), and a dorsal view alone (84.2% +/- 3.6%). Conclusion: The results of this review might be helpful in choosing the most appropriate diagnostic tool in patients suspected having NBF.