Exeter Test Group, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.
NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK.
BMJ Open. 2019 Mar 30;9(3):e026012. doi: 10.1136/bmjopen-2018-026012.
Although the new generation of cardiac troponin assays have revolutionised the diagnosis of myocardial infarction (MI), their application in triaging patients with suspected acute coronary syndrome requires further investigation. The objectives of the current systematic review are to evaluate the diagnostic accuracy of contemporary and high-sensitivity cardiac troponin assays used in serial testing, versus single-sample testing as a comparator, to identify patients with non-ST-segment-elevation MI in the emergency department.
We will conduct systematic searches of MEDLINE, EMBASE, Science Citation Index, the Cochrane Database of Systematic Reviews and the CENTRAL database covering the period from 1 January 2006 to present, with no restrictions on language or publication status. Two review authors will independently screen studies for inclusion, extract data from eligible studies and assess their methodological quality using Quality Assessment of Diagnostic Accuracy Studies version 2. Studies will be included if they evaluate contemporary or high-sensitivity cardiac troponin assays used in serial testing, in patients presenting to the ED with suspicion of MI. Estimates of sensitivity and specificity from each study will be presented in forest plots and in the receiver-operating characteristics space. If appropriate, we will pool the results using Bayesian hierarchical models that allow correction for imperfect reference standard. We will obtain summary estimates of sensitivity and specificity of alternative testing protocols and compare their accuracy. We will also investigate the impact of prespecified sources of heterogeneity and methodological quality items. If pooling of results is considered inappropriate, we will present our findings in tables and diagrams and will describe them narratively.
No formal ethical approval will be sought, but we will report on the ethical approval of the included studies. Dissemination of findings will be through publications in peer-reviewed journals, presentations at conferences and the websites of the universities.
CRD42018106379.
尽管新一代的心脏肌钙蛋白检测方法已经彻底改变了心肌梗死（MI）的诊断，但在分诊疑似急性冠状动脉综合征患者时，还需要进一步研究其应用。本系统评价的目的是评估在急诊中用于连续检测的当代和高敏心脏肌钙蛋白检测方法的诊断准确性，将其与单次样本检测作为对照，以识别非 ST 段抬高型心肌梗死患者。
我们将对 MEDLINE、EMBASE、科学引文索引、Cochrane 系统评价数据库和 CENTRAL 数据库进行系统搜索，时间范围为 2006 年 1 月 1 日至目前，不限制语言或出版状态。两名综述作者将独立筛选纳入的研究，从合格研究中提取数据，并使用诊断准确性研究质量评估工具第 2 版评估其方法学质量。如果评估了在急诊中疑似 MI 的患者中使用的当代或高敏心脏肌钙蛋白检测方法的连续检测的研究，则将其纳入。将从每个研究中呈现敏感性和特异性的估计值，在森林图和接收器操作特征空间中呈现。如果适当，我们将使用贝叶斯层次模型来汇总结果，该模型允许对不完美的参考标准进行校正。我们将获得替代检测方案的敏感性和特异性的汇总估计值，并比较它们的准确性。我们还将调查异质性和方法学质量项目的预指定来源的影响。如果认为汇总结果不合适，我们将在表格和图表中呈现我们的发现，并进行叙述性描述。
不会寻求正式的伦理批准，但我们将报告纳入研究的伦理批准情况。研究结果的传播将通过在同行评议期刊上发表、在会议上发表和在大学网站上发布来进行。
PROSPERO 注册号：CRD42018106379。
