Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism

被引：45

作者：

Patel, Parth ^{[1
]}

Patel, Payal ^{[2
]}

Bhatt, Meha ^{[3
]}

Braun, Cody ^{[4
]}

Begum, Housne ^{[3
]}

Wiercioch, Wojtek ^{[3
]}

Varghese, Jamie ^{[1
]}

Wooldridge, David ^{[1
]}

Alturkmani, Hani ^{[1
]}

Thomas, Merrill ^{[1
]}

Baig, Mariam ^{[1
]}

Bahaj, Waled ^{[1
]}

Khatib, Rasha ^{[5
]}

Kehar, Rohan ^{[6
]}

Ponnapureddy, Rakesh ^{[1
]}

Sethi, Anchal ^{[1
]}

Mustafa, Ahmad ^{[1
]}

Lim, Wendy ^{[7
,8
]}

Le Gal, Gregoire ^{[9
]}

Bates, Shannon M. ^{[7
,10
]}

Haramati, Linda B. ^{[11
,12
]}

Kline, Jeffrey ^{[13
]}

Lang, Eddy ^{[14
]}

Righini, Marc ^{[15
]}

Kalot, Mohamad A. ^{[16
]}

Husainat, Nedaa M. ^{[16
]}

Al Jabiri, Yazan Nayif ^{[17
]}

Schunemann, Holger J. ^{[3
,7
]}

Mustafa, Reem A. ^{[3
,16
]}

机构：

[1] Univ Missouri, Dept Med, Kansas City, MO USA

[2] Univ Illinois, Dept Emergency Med, Chicago, IL USA

[3] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[4] Loyola Univ Med Ctr, Dept Med, Maywood, IL USA

[5] Advocate Res Inst, Advocate Hlth Care, Oak Lawn, IL USA

[6] Western Univ, Div Hematol, London, ON, Canada

[7] McMaster Univ, Dept Med, Hamilton, ON, Canada

[8] McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON, Canada

[9] Univ Ottawa, Dept Med, Ottawa Hosp, Res Inst, Ottawa, ON, Canada

[10] McMaster Univ, Thrombosis & Atherosclerosis Res Inst, Hamilton, ON, Canada

[11] Albert Einstein Coll Med, Montefiore Med Ctr, Dept Radiol, Bronx, NY USA

[12] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Med, Bronx, NY 10467 USA

[13] Indiana Univ Sch Med, Dept Emergency Med, Indianapolis, IN USA

[14] Univ Calgary, Cumming Sch Med, Dept Emergency Med, Calgary, AB, Canada

[15] Univ Geneva, Dept Med Specialties, Div Angiol & Hemostasis, Hosp & Fac Med, Geneva, Switzerland

[16] Univ Kansas, Dept Med, Div Nephrol & Hypertens, Med Ctr, 3901 Rainbow Blvd,MS3002, Kansas City, KS 66160 USA

[17] Specialty Hosp Jaber Ibn Hayyan St Shmeisani, Amman, Jordan

来源：

BLOOD ADVANCES | 2020年 / 4卷 / 18期

关键词：

QUANTITATIVE D-DIMER; COMPUTED-TOMOGRAPHY; VENOUS THROMBOEMBOLISM; CLINICAL PROBABILITY; HELICAL CT; UNITED-STATES; LEG VEINS; ANGIOGRAPHY; PERFORMANCE; EXCLUSION;

D O I：

10.1182/bloodadvances.2019001052

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Pulmonary embolism (PE) is a common, potentially life-threatening yet treatable condition. Prompt diagnosis and expeditious therapeutic intervention is of paramount importance for optimal patient management. Our objective was to systematically review the accuracy of D-dimer assay, compression ultrasonography (CUS), computed tomography pulmonary angiography (CTPA), and ventilation-perfusion (V/Q) scanning for the diagnosis of suspected first and recurrent PE. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. 2 investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 61 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.97 (95% confidence interval [CI], 0.96-0.98) and 0.41 (95% CI, 0.36-0.46) respectively, whereas CTPA sensitivity and specificity were 0.94 (95% CI, 0.89-0.97) and 0.98 (95% CI, 0.97-0.99), respectively, and CUS sensitivity and specificity were 0.49 (95% CI, 0.31-0.66) and 0.96 (95% CI, 0.95-0.98), respectively. Three variations of pooled estimates for sensitivity and specificity of V/Q scan were carried out, based on interpretation of test results. D-dimer had the highest sensitivity when compared with imaging. CTPA and V/Q scans (high probability scan as a positive and low/non-diagnostic/normal scan as negative) both had the highest specificity. This systematic review was registered on PROSPERO as CRD42018084669.

引用

页码：4296 / 4311

页数：16

共 81 条

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