超声检查对儿童肠套叠诊断的准确性：一项系统评价和Meta分析
Diagnostic Accuracy of Ultrasonography for Detection of Intussusception in Children; a Systematic Review and Meta-Analysis.
作者信息
Rahmani Erfan, Amani-Beni Reza, Hekmatnia Yasaman, Fakhre Yaseri Amirhossein, Ahadiat Seyed-Amirabbas, Talebi Boroujeni Parham, Kiani Moein, Tavakoli Reza, Shafagh Seyyed-Ghavam, Shirazinia Matin, Garousi Setareh, Mottahedi Mehran, Arzaghi Mohammadreza, Pourbagher Benam Sasan, Rigi Amir, Salmani Amir, Abdollahi Zeynab, Karimzade Rokni Fateme, Nikbakht Tara, Azizi Hassan Abadi Saeme, Roohinezhad Roozbeh, Masheghati Forough, Haririan Yas, Darouei Bahar, Fayyazishishavan Ehsan, Manoochehri-Arash Niusha, Farrokhi Mehrdad
机构信息
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
Arch Acad Emerg Med. 2023 Feb 28;11(1):e24. doi: 10.22037/aaem.v11i1.1914. eCollection 2023.
INTRODUCTION
The diagnosis of intussusception can be challenging in children due to the fact that the findings of clinical evaluations are nonspecific and most of the patients present with unclear history. Therefore, in this systematic review and meta-analysis, we aimed to investigate the diagnostic accuracy of ultrasonography for detection of intussusception and also compare the efficacy of point-of-care ultrasound (POCUS) with radiologist-performed ultrasound (RADUS).
METHODS
Two independent reviewers systematically searched different online electronic databases including MEDLINE, Scopus, Web of Science, Google Scholar, Embase, and Cochrane from inception to December 1, 2022 to identify published papers reporting accuracy of ultrasonography for diagnosis of intussusception. The quality assessment of the included studies was investigated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool.
RESULTS
A total of 1446 records were retrieved in the initial search of databases. After screening the titles, a total of 344 studies were retrieved for the detailed assessment of full-text. Finally, 37 studies were included in qualitative and quantitative analysis. The pooled sensitivity and specificity of ultrasonography for diagnosis of intussusception were 0.96 (95% CI: 0.95-0.97) and 0.97 (95% CI: 0.97-0.98), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 24.57 (95% CI: 8.26-73.03) and 0.05 (95% CI: 0.04-0.08), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.989. Mete-regression showed that there is no significant difference between diagnostic performance of POCUS and RADUS (p = 0.06 and rDOR (diagnostic odds ratio) = 4.38 (95% CI: 0.92-20.89)).
CONCLUSION
This meta-analysis shows that ultrasonography has excellent sensitivity, specificity, and accuracy for diagnosis of intussusception in pediatric patients. Moreover, we found that diagnostic performance of POCUS is similar to that of RADUS for diagnosis of intussusception.
引言
由于临床评估结果缺乏特异性且大多数患者病史不明，小儿肠套叠的诊断具有挑战性。因此，在本系统评价和荟萃分析中，我们旨在研究超声检查对肠套叠的诊断准确性，并比较床旁超声（POCUS）与放射科医生操作的超声（RADUS）的效能。
方法
两名独立的评审员系统地检索了不同的在线电子数据库，包括MEDLINE、Scopus、Web of Science、谷歌学术、Embase和Cochrane，检索时间从数据库建立至2022年12月1日，以识别报告超声检查诊断肠套叠准确性的已发表论文。使用诊断准确性研究质量评估（QUADAS）-2工具对纳入研究的质量进行评估。
结果
在数据库的初始检索中，共检索到1446条记录。在筛选标题后，共检索到344项研究进行全文详细评估。最后，37项研究纳入定性和定量分析。超声检查诊断肠套叠的合并敏感性和特异性分别为0.96（95%CI：0.95-0.97）和0.97（95%CI：0.97-0.98）。合并阳性似然比（PLR）和阴性似然比（NLR）分别为24.57（95%CI：8.26-73.03）和0.05（95%CI：0.04-0.08）。分层汇总接受者操作特征（HSROC）曲线下面积为0.989。Meta回归显示，POCUS和RADUS的诊断性能无显著差异（p = 0.06，诊断比值比（DOR）= 4.38（95%CI：0.92-20.89））。
结论
本荟萃分析表明，超声检查对小儿肠套叠的诊断具有出色的敏感性、特异性和准确性。此外，我们发现POCUS对肠套叠的诊断性能与RADUS相似。
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