Accuracy of biomarkers to diagnose acute cardiac ischemia in the emergency department: A meta-analysis

Balk, Ethan M; Ioannidis, John P. A.; Salem, Deeb N.; Chew, Priscilla; Lau, Joseph

doi:10.1067/mem.2001.114905

Cited by 119 publications

(73 citation statements)

References 57 publications

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“…Two metaanalyses of the same clinical problem but with different restrictions of patient selection were analyzed as one metaanalysis. 20,34 Another meta-analysis had to be split into 4 separate meta-analyses because of differences in test techniques between the studies. 46 Because of the exclusion of some primary studies (Fig.…”

Section: Resultsmentioning

confidence: 99%

Evidence of bias and variation in diagnostic accuracy studies

Rutjes

Reitsma

Nisio

et al. 2006

CMAJ

508

389

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A lthough the number of test evaluations in the literature is increasing, much remains to be desired in terms of methodology. A series of surveys have shown that only a small number of studies of diagnostic accuracy fulfil essential methodologic standards. 1-3Shortcomings in the design of clinical trials are known to affect results. The biasing effects of inadequate randomization procedures and differential dropout have been discussed and demonstrated in several publications.4-6 A growing understanding of the potential sources of bias and variation has led to the development of guidelines to help researchers and readers in the reporting and appraisal of results from randomized trials.7,8 More recently, similar guidelines have been published to assess the quality of reporting and design of studies evaluating the diagnostic accuracy of tests. For many of the items in these guidelines, there is no or limited empirical evidence available on their potential for bias. 9In principle, such evidence can be collected by comparing studies that have design deficiencies with studies of the same test that have no such imperfections. Several large metaanalyses have used a meta-regression approach to account for differences in study design.10-12 Lijmer and colleagues examined a number of published meta-analyses and showed that studies that involved nonrepresentative patients or that used different reference standards tended to overestimate the diagnostic performance of a test.13 They looked at the influence of 6 methodologic criteria and 3 reporting features on the estimates of diagnostic accuracy in a limited number of clinical problems.We conducted this study of a larger and broader set of meta-analyses of diagnostic accuracy to determine the relative importance of 15 design features on estimates of diagnostic accuracy. Methods Data sources: systematic reviewsAn electronic search strategy was developed to identify all systematic reviews of studies evaluating the diagnostic accuracy of tests that were published between January 1999 and April 2002 in MEDLINE (OVID and PubMed), EMBASE (OVID), the Database of Abstracts of Reviews of Effect (DARE) of the Centre for Reviews and Dissemination (www.york.ac.uk/inst/crd Evidence of bias and variation in diagnostic accuracy studiesBackground: Studies with methodologic shortcomings can overestimate the accuracy of a medical test. We sought to determine and compare the direction and magnitude of the effects of a number of potential sources of bias and variation in studies on estimates of diagnostic accuracy. Methods:We identified meta-analyses of the diagnostic accuracy of tests through an electronic search of the databases MEDLINE, EMBASE, DARE and MEDION (1999-2002). We included meta-analyses with at least 10 primary studies without preselection based on design features. Pairs of reviewers independently extracted study characteristics and original data from the primary studies. We used a multivariable metaepidemiologic regression model to investigate the direction and strength of the a...

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Section: Resultsmentioning

confidence: 99%

Evidence of bias and variation in diagnostic accuracy studies

Rutjes

Reitsma

Nisio

et al. 2006

CMAJ

508

389

View full text Add to dashboard Cite

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“…It was reported that sensitivity to troponin T and I in showing the heart muscle damage were virtually 100% and specificities 95% in hours from two to six (32,33). Because of their high tissue sensitivity and specificity, troponin T and I are better biomarkers than others, such as creatine kinase-MB fraction (34,35).…”

Section: Discussionmentioning

confidence: 99%

Acute cardiotoxic effects of high dose toluene: an experimental study

Taş

Ekici²,

Koç³

et al. 2012

Anadolu Kardiyol Derg

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Objective: This study aimed to investigate the acute cardiotoxic effects of high dose toluene and its damage mechanisms on heart tissue in the acute period. Methods: Twenty adult male Wistar Albino rats (200-220 g) were used in this controlled experimental animal study. Animals were divided into two equal groups: a control group (Group 1) and a high dose (6 mL/kg/gavage) toluene-administered group (Group 2). Arterial blood pressure (BP) and heart rate (HR) values were measured at 30 th , 60 th and 90 th minutes after toluene was administered. At the end of the experimental period, blood samples and heart tissues were taken from the rats. Serum troponin T levels were assayed. Heart tissue sections were stained using routine histological methods and examined under a light microscope. In addition, the sections were immunohistochemically stained using the avidin-biotin-peroxidase method to determine caspase-3 immunoreactivity and TUNEL to detect apoptosis. To compare the apoptotic index, the Mann-Whitney U test was used. For comparisons between the two groups, the independent t-test was used. In addition, time-based changes of intra-group parameters were evaluated using paired t tests. Results: BP and HR values were low in toluene-treated rats compared to the control group. Troponin T levels were increased in tolueneadministered animals as compared with controls [Toluene group: 0.140 (0.010-2.000) ng/mL vs control group: 0.010 (0.010-0.010) ng/mL, p=0.01]. Histopathologic examination of heart tissue sections showed congestion and edema in toluene administrated rats. Higher TUNEL positivity and (+++) immunoreactivity for caspase-3 protein were observed in the toluene group compared to the control group.

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“…The recommended time between the first and second blood draw is 6 to 7 hours. [18] If cardiac marker levels are not elevated but clinical suspicion remains high, a third set of markers should be drawn at 12 to 24 hours after presentation. [19] The markers currently used in this multimarker approach are myoglobin, CKMB, and troponin.…”

Section: Cardiac Biomarkersmentioning

confidence: 99%