The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism after Severe Trauma

Velmahos, George C.; Brown, Carlos; Δημητριάδης, Δημήτριος

doi:10.1177/000313480607200102

Cited by 4 publications

(1 citation statement)

References 24 publications

(19 reference statements)

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“…Our initial systematic search yielded 6378 unique articles. Of these, 93 studies were selected for eligibility through full-text assessment of which 62 studies were finally included 17–78. Six further studies were included by examining the reference list of included publications 79–84…”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of focused deep venous, lung, cardiac and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis

Falster

Jacobsen

Coman

et al. 2021

Thorax

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ObjectiveTo determine the diagnostic accuracy of point-of-care ultrasound in suspected pulmonary embolism.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase, CINAHL and Cochrane library were searched on 2 July 2020 with no restrictions on the date of publication. Subject headings or subheadings combined with text words for the concepts of pulmonary embolism, ultrasound and diagnosis were used.Eligibility criteria and data analysisEligible studies reported sensitivity and specificity of deep venous, lung, cardiac or multiorgan ultrasound in patients with suspected pulmonary embolism, using an adequate reference-test. Prospective, cross-sectional and retrospective studies were considered for eligibility. No restrictions were made on language. Studies were excluded if a control group consisted of healthy volunteers or if transesophageal or endobronchial ultrasound was used. Risk of bias was assessed using quality assessment of diagnostic accuracy studies-2. Meta-analysis of sensitivity and specificity was performed by construction of hierarchical summary receiver operator curves. I2 was used to assess the study heterogeneity.Main outcome measuresThe primary outcome was overall sensitivity and specificity of reported ultrasound signs, stratified by organ approach (deep venous, lung, cardiac and multiorgan). Secondary outcomes were stratum-specific sensitivity and specificity within subgroups defined by pretest probability of pulmonary embolism.Results6378 references were identified, and 70 studies included. The study population comprised 9664 patients with a prevalence of pulmonary embolism of 39.9% (3852/9664). Risk of bias in at least one domain was found in 98.6% (69/70) of included studies. Most frequently, 72.8% (51/70) of studies reported >24 hours between ultrasound examination and reference test or did not disclose time interval at all. Level of heterogeneity ranged from 0% to 100%. Most notable ultrasound signs were bilateral compression of femoral and popliteal veins (22 studies; 4708 patients; sensitivity 43.7% (36.3% to 51.4%); specificity 96.7% (95.4% to 97.6%)), presence of at least one hypoechoic pleural-based lesion (19 studies; 2134 patients; sensitivity 81.4% (73.2% to 87.5%); specificity 87.4% (80.9% to 91.9%)), D-sign (13 studies; 1579 patients; sensitivity 29.7% (24.6% to 35.4%); specificity 96.2% (93.1% to 98.0%)), visible right ventricular thrombus (5 studies; 995 patients; sensitivity 4.7% (2.7% to 8.1%); specificity 100% (99.0% to 100%)) and McConnell’s sign (11 studies; 1480 patients; sensitivity 29.1% (20.0% to 40.1%); specificity 98.6% (96.7% to 99.4%)).ConclusionSeveral ultrasound signs exhibit a high specificity for pulmonary embolism, suggesting that implementation of ultrasound in the initial assessment of patients with suspected pulmonary embolism may improve the selection of patients for radiation imaging.PROSPERO registration numberCRD42020184313.

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Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of focused deep venous, lung, cardiac and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis

Falster

Jacobsen

Coman

et al. 2021

Thorax

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The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism After Severe Trauma

Mozingo¹

2007

Yearbook of Surgery

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

Rodrigues¹,

Alzuphar²,

Combescure³

et al. 2016

Journal of Thrombosis and Haemostasis

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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.

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The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism after Severe Trauma

Cited by 4 publications

References 24 publications

Diagnostic accuracy of focused deep venous, lung, cardiac and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis

Diagnostic accuracy of focused deep venous, lung, cardiac and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis

The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism After Severe Trauma

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

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