Diagnostic accuracy of lung ultrasound for pulmonary embolism:a systematic review and meta-analysis.
J Thromb Haemost. 2013 Apr 10;
Authors: Squizzato A, Rancan E, Dentali F, Bonzini M, Guasti L, Steidl L, Mathis G, Ageno W
Abstract
BACKGROUND: Computed tomographic pulmonary angiography (CTPA) has simplified the diagnostic approach to patients with suspected pulmonary embolism (PE). However, PE diagnosis is still probabilistic and CTPA should be used with caution in some patient groups, such as patients with severe renal insufficiency and pregnant women. Among alternative imaging tests, lung ultrasound is the most promising technique. We aimed to systematically assess the diagnostic accuracy of lung ultrasound for PE diagnosis METHODS: Studies evaluating the diagnostic accuracy of lung ultrasound for the diagnosis of PE were systematically searched in the MEDLINE and EMBASE databases (up to June 2012). QUADAS - 2 tool was used for the quality assessment of the primary studies. A bivariate random-effects regression approach was used for summary estimates of both sensitivity and specificity. RESULTS: Ten studies, for a total 887 patients, were included. A composite reference test was used in 6 studies, with single-row detector CTPA as the principal imaging test in 4 studies. Overall, 7 studies used a proper reference test. Lung ultrasound bivariate weighted mean sensitivity was 87.0% (95% confidence interval [CI] 79.5, 92.0%), whereas bivariate weighted mean specificity was 81.8% (95% CI 71.0, 89.3%). CONCLUSIONS: Our findings suggest that lung ultrasound may be a useful diagnostic tool in the management of patients with suspected PE. However, several methodological drawbacks of the primary studies limit any definite conclusion. Further well-designed accuracy studies are necessary before planning diagnostic management studies, in particular in those with a contraindication for CTPA This article is protected by copyright. All rights reserved.
PMID: 23574640 [PubMed - as supplied by publisher]