Diagnostic characteristics of lower limb venous compression ultrasonography in suspected pulmonary embolism: a meta‐analysis

Abstract

To cite this article: Da Costa Rodrigues J, Alzuphar S, Combescure C, Le Gal G, Perrier A. Diagnostic characteristics of lower limb venous compression ultrasonography in suspected pulmonary embolism: a meta-analysis. J Thromb Haemost 2016; 14: 1765-72. Essentials• Lower limb ultrasonography (CUS) could be useful in suspected pulmonary embolism (PE).• We performed a metaanalysis on the diagnostic characteristics of CUS in suspected PE.• With a sensitivity of 41%, proximal CUS would be positive in one of every 7.3 patients.• Complete CUS has a higher sensitivity but specificity for PE is too low to use it in suspected PE. , 36-46%) with strong heterogeneity (I square, 79%). Specificity of proximal CUS was 96% (95% CI, 94-98%). The overall positive likelihood ratio for proximal CUS was 11.9 (95% CI, 7.1-19.8), whereas the overall negative likelihood ratio was 0.6 (95% CI, 0.5-0.7). The sensitivity of whole-leg CUS was 79% (95% CI, 24-98%) and specificity was 84% (95% CI, 76-90%). Conclusions: Proximal CUS has low sensitivity and cannot be used to rule out PE. Nevertheless, its high specificity allows confirming PE, which may be useful in patients with contraindications to CT angiography. Whole-leg CUS has a higher sensitivity but low specificity for PE and can therefore not be recommended.

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

“…A positive proximal CUS result has a high positive predictive value for PE. The high diagnostic specificity (96%) along with a low sensitivity (41%) of CUS in this setting was shown by a recent meta-analysis [165,166]. CUS is a useful procedure in the diagnostic strategy of patients with CT contraindications.…”

Diagnosis of acute pulmonary embolism

“…It may be used in patients with suspected PE. Indeed, the presence of a proximal DVT is highly predictive of PE, allowing to rule for the diagnosis of PE without further thoracic imaging : A recent systematic review of the performances of CUS for diagnosing PE reported a sensitivity of 41% (95% confidence interval [CI], 36–46%) and a specificity of 96% (95% CI, 94–98%) .…”

State-of-the-Art Imaging in Pulmonary Embolism: Ventilation/Perfusion Single-Photon Emission Computed Tomography versus Computed Tomography Angiography — Controversies, Results, and Recommendations from a Systematic Review

“…Although the specificity of proximal CUS was very high (96%), the authors advised caution as most included studies did not rigorously confirm the presence of PE in patients with positive CUS. 48 The use of a composite reference standard is, however, not without practical challenges as it is based on consensus. Thus, if this consensus cannot be reached, the equivocal studies usually have to be excluded from analysis.…”