Diagnosis of deep vein thrombosis of the lower extremity: a systematic review and meta-analysis of test accuracy
| Autor: | Shannon M. Bates, Rasha Khatib, Cody Braun, Mohamad A. Kalot, Robby Nieuwlaat, Jamie Varghese, Grégoire Le Gal, Parth Patel, Ahmad Mustafa, David Wooldridge, Meha Bhatt, Eddy Lang, Hani J Alturkmani, Waled Bahaj, Holger J. Schünemann, Rohan Kehar, Wojtek Wiercioch, Housne Ara Begum, Yazan Nayif Al Jabiri, Merrill Thomas, Payal M. Patel, Marc Philip Righini, Rakesh Ponnapureddy, Wendy Lim, Reem A. Mustafa, Anchal Sethi, Nedaa Husainat, Mariam Baig |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Deep vein MEDLINE 030204 cardiovascular system & hematology Sensitivity and Specificity 03 medical and health sciences 0302 clinical medicine Deep vein thrombosis Internal medicine parasitic diseases Humans Medicine 030212 general & internal medicine Ultrasonography Venous Thrombosis ddc:616 Leg business.industry Compression Hematology medicine.disease Thrombosis Confidence interval Fibrin fragment d substance Pulmonary embolism Pre- and post-test probability Fibrin d-dimer assay medicine.anatomical_structure Lower Extremity Meta-analysis Systematic Review Pulmonary Embolism business Leg deep vein thrombosis |
| Zdroj: | Blood advances, Vol. 4, No 7 (2020) pp. 1250-1264 |
| ISSN: | 2473-9537 2473-9529 |
| Popis: | Deep vein thrombosis (DVT) of the lower extremities can be associated with significant morbidity and may progress to pulmonary embolism and postthrombotic syndrome. Early diagnosis and treatment are important to minimize the risk of these complications. We systematically reviewed the accuracy of diagnostic tests for first-episode and recurrent DVT of the lower extremities, including proximal compression ultrasonography (US), whole leg US, serial US, and high-sensitivity quantitative D-dimer assays. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. Two 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 43 studies. For any suspected DVT, the pooled estimates for sensitivity and specificity of proximal compression US were 90.1% (95% confidence interval [CI], 86.5-92.8) and 98.5% (95% CI, 97.6-99.1), respectively. For whole-leg US, pooled estimates were 94.0% (95% CI, 91.3-95.9) and 97.3% (95% CI, 94.8-98.6); for serial US pooled estimates were 97.9% (95% CI, 96.0-98.9) and 99.8% (95% CI, 99.3-99.9). For D-dimer, pooled estimates were 96.1% (95% CI, 92.6-98.0) and 35.7% (95% CI, 29.5-42.4). Recurrent DVT studies were not pooled. Certainty of evidence varied from low to high. This systematic review of current diagnostic tests for DVT of the lower extremities provides accuracy estimates. The tests are evaluated when performed in a stand-alone fashion, and in a diagnostic pathway. The pretest probability of DVT often assessed by a clinical decision rule will influence how, together with sensitivity and specificity estimates, patients will be managed. |
| Databáze: | OpenAIRE |
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