Diagnostic accuracy of combined thoracic and cardiac sonography for the diagnosis of pulmonary embolism: A systematic review and meta-analysis

Abstract

Objectives Computed tomography pulmonary angiography (CTPA) is the diagnostic standard for pulmonary embolism (PE), but is unavailable in many low resource settings. We evaluated the evidence for point of care ultrasound as an alternative diagnostic. Methods Using a PROSPERO-registered, protocol-driven strategy (https://www.crd.york.ac.uk/ PROSPERO, ID = CRD42018099925), we searched MEDLINE, EMBASE, and CINHAL for observational and clinical trials of cardiopulmonary ultrasound (CPUS) for PE. We included English-language studies of adult patients with acute breathlessness, reported according to PRISMA guidelines published in the last two decades (January 2000 to February 2020). The primary outcome was diagnostic accuracy of CPUS compared to reference standard CTPA for detection of PE in acutely breathless adults. Results We identified 260 unique publications of which twelve met all inclusion criteria. Of these, seven studies (N = 3872) were suitable for inclusion in our meta-analysis for diagnostic accuracy (two using CTPA and five using clinically derived diagnosis criterion). Meta-analysis of data demonstrated that using cardiopulmonary ultrasound (CPUS) was 91% sensitive and 81% specific for pulmonary embolism diagnosis compared to diagnostic standard CTPA. When compared to clinically derived diagnosis criterion, CPUS was 52% sensitive

Diagnostic accuracy of cardiopulmonary ultrasound for pulmonary embolism: A systematic review and meta‐analysis

“…Previous meta‐analysis assessing the accuracy of single organ ultrasonography like lung ultrasound or cardiac ultrasound technique revealed lower accuracy parameters compared to our review 6,10 . In addition, the diagnostic accuracy parameters for the cardiopulmonary ultrasound obtained in our review were similar to the previous evidence 23 . This shows that combined lung and cardiac ultrasonography has high amount of applicability in diagnosing a case of pulmonary embolism, especially in resource constrained settings.…”

“…Based on the literature available till date, it is not possible to recommend either single or multiorgan ultrasonography as the first line tool for diagnosis of pulmonary embolism 6,10,23 . However, the findings from our review shows a lot of promise in the applicability of cardiopulmonary ultrasound as an adjunct to gold standard diagnosis by experts or CTPA.…”

Point of care ultrasound in acutely breathless patients-A qualitative study of the enablers and challenges in a teaching hospital in Kenya

“…[6,[11][12][13][14] Review of the literature reveals feasibility and clinical utility of PoCUS by non-radiologists and noncardiologists. [15][16][17][18] Focused cardiopulmonary ultrasound was demonstrated to improve diagnostic accuracy in emergency care in Ghana, particularly in patients with cardiac disease such as cardiogenic shock, congestive heart failure, or acute valvular disease. [19] The use of a clinical-PoCUS integrated approach in low-and middle-income (LMICs) may obviate current limitations of human resource and other resource scarcity.…”

Diagnosis of Pulmonary Embolism

“…A meta-analysis revealed that cardiopulmonary ultrasound (CPUS) sensitivity was 91% and specificity was 81% for PE diagnosis in comparison to CT pulmonary angiography (CTPA) [55]. The BLUE (bedside lung ultrasound in emergency) protocol was made to diagnose PE based on a DVT positive venous duplex combined with TLS.…”

“…The combination may help in decreasing the excessive CTPA done currently [58]. In resource-limited settings such as in developing countries or the absence of CTPA availability, CPUS may have a role in managing PE [55].…”