OBJECTIVES:
The optimal timing of coronary angiography remains unclear following out-of-hospital cardiac arrest (OHCA) without ST elevation on electrocardiogram. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of early angiography versus delayed angiography following OHCA without ST elevation.
DATA SOURCES:
The databases MEDLINE, PubMed EMBASE, and CINHAL, as well as unpublished sources from inception to March 9, 2022.
STUDY SELECTION:
A systematic search was performed for randomized controlled trials of adult patients after OHCA without ST elevation who were randomized to early as compared to delayed angiography.
DATA EXTRACTION:
Reviewers screened and abstracted data independently and in duplicate. The certainty of evidence was assessed for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach. The protocol was preregistered (CRD 42021292228).
DATA SYNTHESIS:
Six trials were included (n = 1,590 patients). Early angiography probably has no effect on mortality (relative risk [RR] 1.04; 95% CI 0.94–1.15; moderate certainty) and may have no effect on survival with good neurologic outcome (RR 0.97; 95% CI 0.87–1.07; low certainty) or ICU length of stay (LOS) (mean difference 0.41 days fewer; 95% CI –1.3 to 0.5 d; low certainty). Early angiography has an uncertain effect on adverse events.
CONCLUSIONS:
In OHCA patients without ST elevation, early angiography probably has no effect on mortality and may have no effect on survival with good neurologic outcome and ICU LOS. Early angiography has an uncertain effect on adverse events.
Background
The diagnostic accuracy of ultrasound (US) for suspected lower extremity deep vein thrombosis (DVT) in nonpregnant patients has been well validated. However, in pregnant women with suspected DVT and an initial negative US, serial US is generally recommended. We aimed to determine the ability of single negative US to exclude DVT in symptomatic pregnant women.
Methods
Two authors independently reviewed the following databases: MEDLINE, PubMed, and EMBASE from inception until February 2019. We assessed the risk of bias using the CLARITY group tool for prognostic studies and performed a random effects meta‐analysis to report the pooled false negative rate of a single leg ultrasound.
Results
Eight studies (seven prospective and one retrospective) were included. An overlap among study populations was identified in four of the manuscripts. Two authors performed data re‐extraction from these hard copy research charts. Risk of bias was low for the included populations and method of measurement, and low or high for completeness of follow up. A total of 635 pregnant patients with symptoms of DVT had an initial negative US examination. Of those, six were diagnosed with DVT during repeat serial testing (0.94%) and three developed DVT or PE during 3‐month follow‐up after serial ultrasonography (0.47%). The pooled false‐negative rate of a single ultrasound was 1.27% (95% confidence interval, 0.42‐2.56), I2 = 27%.
Conclusion
The false‐negative rate is low with a single US for suspected DVT in pregnancy. Our results will help inform shared decision‐making around planning repeat ultrasound scans in these patients.
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