Ultrasound at Scintigraphic “Intermediate Probability of Pulmonary Embolism”

Christiansen, Frank; Kellerth, Thomas; Andersson, Torbjörn; Ragnarsson, Àsgrìmur; Hjortevang, F.

doi:10.1177/02841851960371p104

Cited by 11 publications

(4 citation statements)

References 13 publications

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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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“…In a study of 41 patients with positive abnormalities on pulmonary angiography, the results of leg venography were normal in 12 patients (17) . There are many studies to estimate the prevalence of DVT with PE which indicates wide discrepancies ranging from 10 to 70% in pulmonary angiography based studies and 25 to 93% in V/Q based studies, and in meta-analysis study of the prevalence of DVT in patients suspected PE was 18% and in proven PE 36-45% (16,18,19,20) .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism, seasonal variations in admission to hospital, and the association of calf deep vein thrombosiswith pulmonary embolism

Al-Habbo¹,

Al-Saegh²,

Hammo³

et al. 2009

Ann Coll Med Mosul

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Objective: To look for the presence or absence of seasonal variation of pulmonary embolism (PE). To analyze the effect of age, sex and the presence or absence of deep vein thrombosis(DVT) and its risk factors on the occurrence of PE. To analyze the ECG changes and the presence or absence of sinus tachycardia in patients with acute PE. Method: One hundred three patients with PE were studied retrospectively, during the years 2002-2007 at the intensive and respiratory care unit and general medical units in Ibn-Sena Teaching Hospital. Results: One hundred three patients with PE were studied. The age of the patients correlates significantly with the presence of PE being highest between 21-50 year of age, with p-value of <0.001. There were no seasonal variations in the distribution of PE with P-value of 0.06. Females significantly outnumbered male patients with P-value of 0.002. There was no statistically significant association between the clinically evident DVT or its absence and the diagnosis of PE with p-value 0.278. The association between the presence of PE and positive doppler ultrasound for DVT were significant with p-value of 0.023. There was a significant association between the presence of PE and sinus tachycardia with p-value of <0.001, and negative correlation with the classical ECG changes. Conclusion: There was no seasonal variation in the distribution of PE. There was significant association between the presence of PE and positive doppler ultrasound for DVT. Sinus tachycardias were commonly present with acute PE. We need to have more sophisticated facilities for proper diagnosis of PE.

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“…Deep vein thrombosis was detected in only 14% of all patients. These findings remain to be confirmed, since other accuracy studies were limited by their retrospective study design, small sample sizes or due to the absence of a blinded assessment of ultrasonography results (6)(7)(8)(9)(10)(11). Secondly, the optimal extent to which the deep venous system needs to be ultrasonographically examined in patients with suspected pulmonary embolism is unclear.…”

Section: Introductionmentioning

confidence: 98%

Compression Ultrasonography of the Leg Veins in Patients with Clinically Suspected Pulmonary Embolism

Gillavry

Sanson²,

Büller³

et al. 2000

Thromb Haemost

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SummaryWe performed a multi-center study in consecutive patients with suspected pulmonary embolism to compare the diagnostic accuracy of a two-point compression ultrasonography (only the common femoral vein and popliteal vein) with an extensive examination of compressibility (from the common femoral vein until the trifurcation of calf veins). A total of 479 patients underwent the two-point compression ultrasonography. The prevalence of pulmonary embolism was 32%. The sensitivity and specificity of this procedure were 23% (95% CI 19-26) and 98% (95% CI 96-99), respectively. Extensive compression ultrasonography was performed in 461 (96%) of these 479 patients and showed comparable accuracy indices (sensitivity 25%, 95% CI 20-28 and specificity 97%, 95% CI 95-99). We conclude that compression ultrasonography has a limited sensitivity for the detection of thrombosis in patients with acute pulmonary embolism within 24 h of presentation. A more extensive assessment of compressibility of the leg veins in these patients has no additional value as compared to the two-point assessment.

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Ultrasound at Scintigraphic “Intermediate Probability of Pulmonary Embolism”

Cited by 11 publications

References 13 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

Pulmonary embolism, seasonal variations in admission to hospital, and the association of calf deep vein thrombosiswith pulmonary embolism

Compression Ultrasonography of the Leg Veins in Patients with Clinically Suspected Pulmonary Embolism

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