Patel Parth, Patel Payal, Bhatt Meha, Braun Cody, Begum Housne, Wiercioch Wojtek, Varghese Jamie, Wooldridge David, Alturkmani Hani, Thomas Merrill, Baig Mariam, Bahaj Waled, Khatib Rasha, Kehar Rohan, Ponnapureddy Rakesh, Sethi Anchal, Mustafa Ahmad, Lim Wendy, Le Gal Grégoire, Bates Shannon M, Haramati Linda B, Kline Jeffrey, Lang Eddy, Righini Marc, Kalot Mohamad A, Husainat Nedaa M, Jabiri Yazan Nayif Al, Schünemann Holger J, Mustafa Reem A
Department of Medicine, University of Missouri, Kansas City, MO.
Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL.
Blood Adv. 2020 Sep 22;4(18):4296-4311. doi: 10.1182/bloodadvances.2019001052.
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.
肺栓塞（PE）是一种常见的、可能危及生命但可治疗的疾病。及时诊断和迅速的治疗干预对于优化患者管理至关重要。我们的目的是系统评价D-二聚体检测、加压超声检查（CUS）、计算机断层扫描肺动脉造影（CTPA）和通气-灌注（V/Q）扫描对疑似首次和复发性PE诊断的准确性。我们检索了Cochrane中心、MEDLINE和EMBASE以查找符合条件的研究、相关综述的参考文献列表、注册试验和相关会议记录。两名研究人员筛选并提取数据。使用诊断准确性研究质量评估-2评估偏倚风险，并使用推荐分级评估、制定和评价框架评估证据的确定性。我们汇总了敏感性和特异性的估计值。该综述纳入了61项研究。D-二聚体敏感性和特异性的汇总估计值分别为0.97（95%置信区间[CI]，0.96-0.98）和0.41（95%CI，0.36-0.46），而CTPA敏感性和特异性分别为0.94（95%CI，0.89-0.97）和0.98（95%CI，0.97-0.99），CUS敏感性和特异性分别为0.49（95%CI，0.31-0.66）和0.96（95%CI，0.95-0.98）。基于对检测结果的解读，对V/Q扫描敏感性和特异性的汇总估计值进行了三种变化。与影像学检查相比，D-二聚体具有最高的敏感性。CTPA和V/Q扫描（高概率扫描为阳性，低/非诊断性/正常扫描为阴性）均具有最高的特异性。该系统评价已在PROSPERO上注册，注册号为CRD42018084669。
