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

ABSTRACT: 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.

SUBMITTER: Patel P

PROVIDER: S-EPMC7509887 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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

Patel Parth P Patel Payal P Bhatt Meha M Braun Cody C Begum Housne H Wiercioch Wojtek W Varghese Jamie J Wooldridge David D Alturkmani Hani H Thomas Merrill M Baig Mariam M Bahaj Waled W Khatib Rasha R Kehar Rohan R Ponnapureddy Rakesh R Sethi Anchal A Mustafa Ahmad A Lim Wendy W Le Gal Grégoire G Bates Shannon M SM Haramati Linda B LB Kline Jeffrey J Lang Eddy E Righini Marc M Kalot Mohamad A MA Husainat Nedaa M NM Jabiri Yazan Nayif Al YNA Schünemann Holger J HJ Mustafa Reem A RA

Blood advances 20200901 18

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 ...[more]

PMID: 32915980

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Project description:ObjectivesTo assess the likelihood ratios of diagnostic strategies for pulmonary embolism and to determine their clinical application according to pretest probability.Data sourcesMedline, Embase, and Pascal Biomed and manual search for articles published from January 1990 to September 2003.Study selectionStudies that evaluated diagnostic tests for confirmation or exclusion of pulmonary embolism. DATA EXTRACTED: Positive likelihood ratios for strategies that confirmed a diagnosis of pulmonary embolism and negative likelihood ratios for diagnostic strategies that excluded a diagnosis of pulmonary embolism.Data synthesis48 of 1012 articles were included. Positive likelihood ratios for diagnostic tests were: high probability ventilation perfusion lung scan 18.3 (95% confidence interval 10.3 to 32.5), spiral computed tomography 24.1 (12.4 to 46.7), and ultrasonography of leg veins 16.2 (5.6 to 46.7). In patients with a moderate or high pretest probability, these findings are associated with a greater than 85% post-test probability of pulmonary embolism. Negative likelihood ratios were: normal or near normal appearance on lung scan 0.05 (0.03 to 0.10), a negative result on spiral computed tomography along with a negative result on ultrasonography 0.04 (0.03 to 0.06), and a d-dimer concentration < 500 mug/l measured by quantitative enzyme linked immunosorbent assay 0.08 (0.04 to 0.18). In patients with a low or moderate pretest probability, these findings were associated with a post-test probability of pulmonary embolism below 5%. Spiral computed tomography alone, a low probability ventilation perfusion lung scan, magnetic resonance angiography, a quantitative latex d-dimer test, and haemagglutination d-dimers had higher negative likelihood ratios and can therefore only exclude pulmonary embolism in patients with a low pretest probability.ConclusionsThe accuracy of tests for suspected pulmonary embolism varies greatly, but it is possible to estimate the range of pretest probabilities over which each test or strategy can confirm or rule out pulmonary embolism.

Dataset Information

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

Publications

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

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