Scientific article
Meta-analysis
OA Policy
English

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

Published inBlood advances, vol. 4, no. 18, p. 4296-4311
Publication date2020
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.

Keywords
  • Humans
  • Pulmonary Embolism* / diagnostic imaging
  • Radionuclide Imaging
  • Sensitivity and Specificity
  • Ultrasonography Ventilation-Perfusion Scan
Citation (ISO format)
PATEL, Parth et al. Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism. In: Blood advances, 2020, vol. 4, n° 18, p. 4296–4311. doi: 10.1182/bloodadvances.2019001052
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Identifiers
Journal ISSN2473-9529
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Creation01/12/2020 08:22:00
First validation01/12/2020 08:22:00
Update time16/03/2023 01:35:04
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