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Meta-Analysis
. 2020 Sep 22;4(18):4296-4311.
doi: 10.1182/bloodadvances.2019001052.

Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism

Parth Patel  1 , Payal Patel  2 , Meha Bhatt  3 , Cody Braun  4 , Housne Begum  3 , Wojtek Wiercioch  3 , Jamie Varghese  1 , David Wooldridge  1 , Hani Alturkmani  1 , Merrill Thomas  1 , Mariam Baig  1 , Waled Bahaj  1 , Rasha Khatib  5 , Rohan Kehar  6 , Rakesh Ponnapureddy  1 , Anchal Sethi  1 , Ahmad Mustafa  1 , Wendy Lim  7   8 , Grégoire Le Gal  9 , Shannon M Bates  10 , Linda B Haramati  11   12 , Jeffrey Kline  13 , Eddy Lang  14 , Marc Righini  15 , Mohamad A Kalot  16 , Nedaa M Husainat  16 , Yazan Nayif Al Jabiri  17 , Holger J Schünemann  3   18 , Reem A Mustafa  3   16
Affiliations
Meta-Analysis

Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism

Parth Patel et al. Blood Adv. .

Abstract

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.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for study selection.
Figure 2.
Figure 2.
Forest plot for all D-dimer assays.
Figure 3.
Figure 3.
Forest plot for Vidas D-dimer assay.
Figure 4.
Figure 4.
Forest plot for Tina-quant D-dimer assay.
Figure 5.
Figure 5.
Forest plot for STA Liatest D-dimer assay.
Figure 6.
Figure 6.
Forest plot for CTPA.
Figure 7.
Figure 7.
Forest plot for CUS.
Figure 8.
Figure 8.
Forest plot for VQ1: high-probability scans considered positive and low/nondiagnostic/normal scans considered negative.
Figure 9.
Figure 9.
Forest plot for VQ2: high/nondiagnostic/low probability scans considered as positive and normal scans as negative.
Figure 10.
Figure 10.
Forest plot for VQ3: high-probability scans considered positive and normal scans considered negative.
See this image and copyright information in PMC

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