Keikha Mojtaba, Salehi-Marzijarani Mohammad, Soldoozi Nejat Reihane, Sheikh Motahar Vahedi Hojat, Mirrezaie Seyed Mohammad
Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.
Department of Biostatistics, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Bull Emerg Trauma. 2018 Oct;6(4):271-278. doi: 10.29252/beat-060402.
To perform a diagnostic accuracy of the rapid ultrasound in shock (RUSH) to diagnose the etiology of undifferentiated shock in patients presenting to the emergency department (ED).
We searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till July 2017. Two independent reviewers screened studies for eligibility. Our study analysis is planned in accordance with the guidelines for meta-analysis of diagnostic studies. In the systematic search, of 397 references, 295 were excluded on the basis of the title and abstract. For the remaining 102 articles, the full text was retrieved and critically reviewed. After the selection process, five papers were included.
The pooled estimate of all data showed that the RUSH protocol exhibited high sensitivity (0.87, 95% Confidence Interval (CI): 0.80-0.92, I2 = 46.7%) and specificity (0.98, 95% C. I.: 0.96-0.99, I2 = 30.8%). The AUC for SROC, a global measure of the RUSH protocol performance, was 0.98 ± 0.01, indicates the high accuracy of the test. Positive and negative likelihood ratios reported from the studies ranged from 9.83 to 51.32 and 0.04 to 0.33, respectively. The pooled estimate of all data showed that the RUSH protocol exhibited high positive likelihood ratio (19.19, 95% C. I.: 11.49-32.06, I2 = 14.1%) and low negative likelihood ratio (0.23, 95% C. I.: 0.15-0.34, I2 = 18.4%).
This meta-analysis suggests that RUSH protocol has generally good role to distinguish the states of shock in patients with undifferentiated shock referred to the emergency department.
评估快速超声休克评估(RUSH)在诊断急诊科(ED)就诊的未分化休克患者病因方面的诊断准确性。
我们通过PubMed、Scopus和ISI Web of Knowledge检索截至2017年7月的Medline。两名独立审稿人筛选符合条件的研究。我们的研究分析按照诊断研究的荟萃分析指南进行规划。在系统检索中,397篇参考文献中有295篇基于标题和摘要被排除。对于其余102篇文章,检索全文并进行严格评审。经过筛选过程,纳入了五篇论文。
所有数据的合并估计显示,RUSH方案具有高敏感性(0.87,95%置信区间(CI):0.80 - 0.92,I² = 46.7%)和特异性(0.98,95% CI:0.96 - 0.99,I² = 30.8%)。SROC的AUC(衡量RUSH方案性能的综合指标)为0.98 ± 0.01,表明该测试具有高准确性。研究报告的阳性和阴性似然比分别为9.83至51.32和0.04至0.33。所有数据的合并估计显示,RUSH方案具有高阳性似然比(19.19,95% CI:11.49 - 32.06,I² = 14.1%)和低阴性似然比(0.23,95% CI:0.15 - 0.34,I² = 18.4%)。
这项荟萃分析表明,RUSH方案在区分转诊至急诊科的未分化休克患者的休克状态方面通常具有良好作用。