Huang Y, Qiu L, Mei A L, Li J X
Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
Zhonghua Shao Shang Za Zhi. 2017 May 20;33(5):301-308. doi: 10.3760/cma.j.issn.1009-2587.2017.05.009.
To evaluate the value of laser Doppler imaging (LDI) in diagnosing deep or superficial partial-thickness burn wound with meta-analysis. Databases including were searched using key words " burn, burns, burn depth, laser Doppler imaging, laser Doppler perfusion imaging, LDI, LDPI" , and - were searched using Chinese key words ",,,," to obtain the published trials of LDI in diagnosing deep or superficial partial-thickness burn wound from the establishment of each database to October 2015. The risk of bias and applicability concerns of the included studies were evaluated by Quality Assessment of Diagnostic Accuracy Studies-2. Data were processed with Meta-DiSc 1.4 statistical software. The heterogeneity among the included studies was evaluated. The pooled estimates of LDI in diagnosing deep or superficial partial-thickness burn wound in the included studies, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, as well as the area under the curve of summary receiver operating characteristic and index of () were calculated. The stability of results of the overall pooled estimates of the included studies was validated by sensitivity analysis. The sources of heterogeneity among the included studies were sought through subgroup analysis. The publication bias caused by the results of the included studies was evaluated by drawing the Deek's funnel plot. A total of 5 articles conforming to the inclusion criteria, involving 138 patients and 179 burn wounds, were included. One of the included studies had low risk of bias, while the other 4 studies had high/unclear risk of bias. In applicability concern aspect, one of the included studies had high/unclear concerns regarding applicability, while the other 4 studies had low concerns regarding applicability. There was no heterogeneity caused by threshold effects among the included studies (no " shoulder arm" plot of the scattered-point distribution was observed in the space of the receiver operating characteristic, (s)=0.01, >0.05). There was a high heterogeneity caused by non-threshold effects among the included studies (sensitivity (2)=54%). The overall pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of the included studies on LDI in diagnosing deep or superficial partial-thickness burn wound were 95% (with 95% confidence interval 88%-99%), 96% (with 95% confidence interval 90%-99%), 9.75 (with 95% confidence interval 4.35-21.81), 0.11 (with 95% confidence interval 0.05-0.22), and 257.93 (with 95% confidence interval 58.96-1 128.41), respectively. The area under the curve of summary receiver operating characteristic was 0.98, with index of () 94%. The results of the overall pooled estimates of the included studies was stable. The risk of bias of the selection of the patients, equipment type of LDI, and the selection of diagnostic method in control might be sources of the heterogeneity of the included studies. The Deek's funnel plot indicated that there was no publication bias caused by the results of the included studies (>0.05). LDI has high sensitivity, specificity, positive likelihood ratio, diagnostic odds ratio and index of (*,) large area under the curve of summary receiver operating characteristics, and low negative likelihood ratio in diagnosing deep or superficial partial-thickness burn wound, which has relatively high diagnostic value.
采用Meta分析评价激光多普勒成像(LDI)诊断深Ⅱ度或浅Ⅱ度烧伤创面的价值。使用关键词“burn, burns, burn depth, laser Doppler imaging, laser Doppler perfusion imaging, LDI, LDPI”检索包括 在内的数据库,并使用中文关键词“,,,,”检索 - ,以获取从各数据库建立至2015年10月LDI诊断深Ⅱ度或浅Ⅱ度烧伤创面的已发表试验。采用诊断准确性研究的质量评估-2对纳入研究的偏倚风险和适用性问题进行评估。数据用Meta-DiSc 1.4统计软件处理。评估纳入研究之间的异质性。计算纳入研究中LDI诊断深Ⅱ度或浅Ⅱ度烧伤创面的合并估计值,包括敏感度、特异度、阳性似然比、阴性似然比、诊断比值比,以及汇总受试者工作特征曲线下面积和()指数。通过敏感性分析验证纳入研究总体合并估计值结果的稳定性。通过亚组分析寻找纳入研究之间异质性的来源。通过绘制Deek漏斗图评估纳入研究结果引起的发表偏倚。共纳入5篇符合纳入标准的文章,涉及138例患者和179个烧伤创面。纳入研究中1项研究偏倚风险低,其余4项研究偏倚风险高/不明确。在适用性问题方面,纳入研究中1项研究适用性方面存在高/不明确问题,其余4项研究适用性方面存在低问题。纳入研究中未观察到阈值效应导致的异质性(在受试者工作特征空间中未观察到散点分布的“肩臂”图,(s)=0.01,>0.05)。纳入研究中存在非阈值效应导致的高异质性(敏感度(2)=54%)。纳入研究中LDI诊断深Ⅱ度或浅Ⅱ度烧伤创面的总体合并敏感度、特异度、阳性似然比、阴性似然比和诊断比值比分别为95%(95%置信区间88%-99%)、96%(95%置信区间90%-99%)、9.75(95%置信区间4.35-21.81)、0.11(95%置信区间0.05-0.22)和257.93(95%置信区间58.96-1 128.41)。汇总受试者工作特征曲线下面积为0.98,()指数为94%。纳入研究总体合并估计值结果稳定。患者选择、LDI设备类型和对照中诊断方法选择的偏倚风险可能是纳入研究异质性的来源。Deek漏斗图表明纳入研究结果未引起发表偏倚(>0.05)。LDI诊断深Ⅱ度或浅Ⅱ度烧伤创面具有高敏感度、特异度、阳性似然比、诊断比值比和(*,)指数,汇总受试者工作特征曲线下面积大,阴性似然比低,具有较高的诊断价值。