Methodology Score: 3.5/5
Usefulness Score: 4/5
Margaretten ME, Kohlwes J, Moore D, Bent S. JAMA. 2007 Apr 4;297(13):1478-88.
This 2007 systematic review found that (aside from specific clinical scenarios), history, physical exam and lab data were not particularly useful in confirming or ruling out the diagnosis of septic arthritis, and that suspected cases require synovial fluid analysis for better risk stratification. The group was disappointed the study was unable to guide avoidance of arthrocentesis, but found the study useful for informed discussions with consultants and for confirming the diagnostic difficulty of septic arthritis, even with synovial fluid analysis.
By: Dr. Michael Ho
The QUADAS-2 Tool is recommended for evaluating the quality of systematic reviews of primary diagnostic accuracy studies [as opposed to intervention studies]. QUADAS-2 consists of four key domains: patient selection, index test, reference standard, as well as flow and timing. Each is assessed in terms of risk of bias and the first three in terms of concerns regarding applicability. Signalling questions are included to assist in judgements about risk of bias. QUADAS-2 is applied in four phases. http://www.bris.ac.uk/quadas/quadas-2/
By: Dr. Ian Stiell