Zaki Hany A, Albaroudi Bilal, Shaban Eman E, Elgassim Mohamed, Almarri Nood Dhafi, Basharat Kaleem, Shaban Ahmed
Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
Department of Cardiology, Al Jufairi Diagnosis and Treatment, MOH, Doha, Qatar.
Ultrasound J. 2024 Jul 30;16(1):37. doi: 10.1186/s13089-024-00378-1.
The assessment of deep venous thrombosis (DVT) is clinically difficult diagnosis. The "gold standard test" for DVT diagnosis is venography; however, various point-of-care ultrasound (POCUS) protocols have been suggested for DVT evaluation in the emergency department.
This review evaluated the role of different POCUS protocols in diagnosing DVT in the emergency department.
A systematic review and meta-analysis was conducted based of PRISMA guideline and registered on PROSEPRO (CRD42023398871). An electronic database search in Embase, PubMed, ScienceDirect, and Google scholar and a manual search were performed to identify eligible studies till February 2023. Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) was used to assess the risk of bias in included studies. Quantitative analysis was carried out using STATA 16 and Review Manager software (RevMan 5.4.1). Sensitivity, specificity of POCUS protocols for DVT diagnosis compared to reference standard test was calculated.
Heterogeneity was identified between 26 included studies for review. The pooled sensitivity, specificity, PPV, and NPV for the 2-point POCUS protocol were 92.32% (95% CI: 87.58-97.06), 96.86% (95% CI: 95.09-98.64), 88.41% (95% CI: 82.24-94.58) and 97.25% (95% CI: 95.51-98.99), respectively. Similarly, the pooled sensitivity, specificity, PPV, and NPV for 3-point POCUS were 89.15% (95% CI: 83.24-95.07), 92.71% (95% CI: 89.59-95.83), 81.27% (95% CI: 73.79-88.75), and 95.47% (95% CI: 92.93-98). The data pooled for complete compression ultrasound, and whole-leg duplex ultrasound also resulted in a sensitivity and specificity of 100% (95% CI: 98.21-100) and 97.05% (95% CI: 92.25-100), respectively. On the other hand, the time from triage to DVT diagnosis was significantly shorter for emergency physician-performed POCUS than diagnostic tests performed by radiologists.
The diagnostic performance of POCUS protocols performed by emergency physicians was excellent. Combined with the significant reduction in time to diagnosis. POCUS can be used as the first-line imaging tool for DVT diagnosis in the emergency department. We also recommended that attending emergency physicians with POCUS training are present during DVT diagnosis to improve diagnostic performance even though high diagnostic performance is observed even with the minimum training.
深静脉血栓形成（DVT）的评估在临床上诊断困难。DVT诊断的“金标准检查”是静脉造影；然而，已提出各种床旁超声（POCUS）方案用于急诊科的DVT评估。
本综述评估了不同POCUS方案在急诊科诊断DVT中的作用。
根据PRISMA指南进行系统综述和荟萃分析，并在PROSPERO（CRD42023398871）上注册。在Embase、PubMed、ScienceDirect和谷歌学术上进行电子数据库检索，并进行手动检索，以识别截至2023年2月的符合条件的研究。使用诊断准确性研究质量评估工具（QUADAS-2）评估纳入研究中的偏倚风险。使用STATA 16和综述管理器软件（RevMan 5.4.1）进行定量分析。计算了与参考标准检查相比，POCUS方案诊断DVT的敏感性、特异性。
纳入综述的26项研究之间存在异质性。两点POCUS方案的合并敏感性为92.32%（95%CI：87.58-97.06），特异性为96.86%（95%CI：95.09-98.64），阳性预测值为88.41%（95%CI：82.24-94.58），阴性预测值为97.25%（95%CI：95.51-98.99）。同样，三点POCUS方案的合并敏感性为89.15%（95%CI：83.24-95.07），特异性为92.71%（95%CI：89.59-95.83），阳性预测值为81.27%（95%CI：73.79-88.75），阴性预测值为95.47%（95%CI：92.93-98）。完全压迫超声和全腿双功超声的数据合并后，敏感性和特异性分别为100%（95%CI：98.21-100）和97.05%（95%CI：92.25-100）。另一方面，急诊科医生进行POCUS检查从分诊到诊断DVT的时间明显短于放射科医生进行的诊断检查。
急诊科医生执行的POCUS方案的诊断性能优异。结合诊断时间的显著缩短。POCUS可作为急诊科DVT诊断的一线成像工具。我们还建议在DVT诊断期间有接受过POCUS培训的急诊科医生在场，以提高诊断性能，即使在接受最少培训的情况下也能观察到较高的诊断性能。
