Olesen Anne Sophie Overgaard, Miger Kristina, Thune Jens Jakob, Nielsen Olav Wendelboe, Jakobsen Janus Christian, Grand Johannes
Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2025 Jul;69(6):e70042. doi: 10.1111/aas.70042.
Pulmonary congestion and pleural effusion are key manifestations in patients with acute heart failure, contributing to over one million emergency department admissions annually in, respectively, the United States and Europe. Accurate and timely diagnosis is critical for initiating early treatment and optimizing patient outcomes. Routinely used diagnostic tools, such as chest radiography, have limitations in sensitivity and specificity. Emerging imaging modalities, including lung ultrasound, computed tomography (CT), and remote dielectric sensing (ReDS), may offer improved diagnostic accuracy, but their comparative effectiveness remains unclear.
We will conduct a systematic review and meta-analysis following PRISMA-P guidelines to assess the diagnostic accuracy of chest radiography, lung ultrasound, CT, and ReDS for pulmonary congestion and pleural effusion. We will include prospective diagnostic studies comparing these modalities to a reference standard of pulmonary congestion or pleural effusion. Our search will cover MEDLINE, Embase, CENTRAL, and other major databases, without language restrictions. We will begin our search in April 2025. Sensitivity, specificity, and likelihood ratios will be pooled using a hierarchical summary receiver operating characteristic model. Risk of bias will be assessed using QUADAS-2.
This protocol defines the detailed methodology and approach used for a systematic review that will provide a comprehensive assessment of current diagnostic modalities for pulmonary congestion and pleural effusion. By comparing their diagnostic accuracy, we aim to guide clinicians in selecting the most effective tools for clinical practice. Additionally, identifying gaps and the risk of bias in existing research may inform future studies and advancements in acute heart failure diagnostics.
肺淤血和胸腔积液是急性心力衰竭患者的关键表现，在美国和欧洲，每年分别导致超过100万例患者急诊入院。准确及时的诊断对于启动早期治疗和优化患者预后至关重要。常规使用的诊断工具，如胸部X线摄影，在敏感性和特异性方面存在局限性。新兴的成像方式，包括肺部超声、计算机断层扫描（CT）和远程介电传感（ReDS），可能会提高诊断准确性，但其相对有效性仍不明确。
我们将按照PRISMA-P指南进行系统评价和荟萃分析，以评估胸部X线摄影、肺部超声、CT和ReDS对肺淤血和胸腔积液的诊断准确性。我们将纳入将这些方式与肺淤血或胸腔积液参考标准进行比较的前瞻性诊断研究。我们的检索将涵盖MEDLINE、Embase、CENTRAL和其他主要数据库，无语言限制。我们将于2025年4月开始检索。敏感性、特异性和似然比将使用分层汇总接受者操作特征模型进行汇总。将使用QUADAS-2评估偏倚风险。
本方案定义了用于系统评价的详细方法和途径，该评价将对当前肺淤血和胸腔积液的诊断方式进行全面评估。通过比较它们的诊断准确性，我们旨在指导临床医生选择临床实践中最有效的工具。此外，识别现有研究中的差距和偏倚风险可能为未来急性心力衰竭诊断的研究和进展提供参考。
