The diagnostic accuracy of point-of-care ultrasound in shock: a systematic review and meta-analysis.

IF 3.4 3区 医学 Q1 ANESTHESIOLOGY
John Basmaji, J Elaine Tang, Robert Arntfield, Karishma Desai, Ian M Ball, Kyle Fiorini, Marat Slessarev, Kimia Honarmand, Phil Jones, Vincent Lau, Kimberley Lewis, Nicolas Orozco, Maureen Meade, Brian Park, Ross Prager, Bram Rochwerg, Lehana Thabane, Michelle Y S Wong, Gordon Guyatt
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引用次数: 0

Abstract

Purpose: We sought to conduct a systematic review to determine the diagnostic test accuracy of point-of-care ultrasound (POCUS) for the specific etiologies and subtypes of shock.

Methods: We searched MEDLINE, Embase, and the grey literature for prospective studies in adult populations with shock. We collected data on study design, patient characteristics, operator characteristics, POCUS protocol, and true and false positives and negatives, and assessed the risk of bias.

Results: We found 18 eligible studies with a total of N = 2,088 patients. The pooled sensitivity and specificity of POCUS for determining shock subtype were 90% (95% confidence interval [CI], 81 to 95) and 95% (95% CI, 90 to 97) for hypovolemic shock, 95% (95% CI, 84 to 98) and 98% (95% CI, 97 to 99) for cardiogenic shock, 78% (95% CI, 69 to 85) and 97% (95% CI, 94 to 99) for distributive shock, 94% (95% CI, 85 to 97) and 99% (95% CI, 98 to 100) for obstructive shock, and 85% (95% CI, 77 to 91) and 98% (95% CI, 91 to 100) for mixed shock (all low to moderate quality evidence). The pooled sensitivity and specificity of POCUS for determining specific shock etiologies were 78% (95% CI, 18 to 98) and 96% (95% CI, 87 to 99) for sepsis, 92% (95% CI, 71 to 98) and 99% (95% CI, 83 to 100) for pulmonary embolism, and 100% (95% CI, 69 to 100) and 100% (95% CI, 98 to 100) for cardiac tamponade. The quality of the evidence ranged from very low to moderate.

Conclusions: On the basis of very low to moderate quality evidence, POCUS may perform better at ruling in shock subtypes and specific shock etiologies than ruling them out. Point-of-care ultrasound is a promising tool for the diagnosis of shock.

Study registration: PROSPERO ( CRD42020160001 ); first submitted 1 December 2019.

即时超声诊断休克的准确性:系统回顾和荟萃分析。
目的:我们试图进行一项系统的综述,以确定点护理超声(POCUS)对特定病因和休克亚型的诊断测试准确性。方法:我们检索MEDLINE、Embase和灰色文献,寻找成人休克人群的前瞻性研究。我们收集了研究设计、患者特征、操作者特征、POCUS方案、真阳性和假阳性及阴性的数据,并评估了偏倚风险。结果:我们找到18项符合条件的研究,共N = 2088例患者。巫师的合用的敏感性和特异性确定冲击亚型分别为90%(95%可信区间(CI), 81年至95年)和95%(95%可信区间,90年至97年)低血容量性休克,95% (95% CI, 84年至98年)和98%(95%可信区间,97年至99年)心原性休克,78% (95% CI, 69年至85年)和97%(95%可信区间,94年至99年)分配的冲击,94% (95% CI, 85年至97年)和99%(95%可信区间,98年至100年)阻塞性冲击,和85%(95%可信区间,77年至91年)和98%(95%可信区间,91 - 100)为混合性休克(均为低到中等质量证据)。POCUS在确定特定休克病因方面的敏感性和特异性在脓毒症方面分别为78% (95% CI, 18 ~ 98)和96% (95% CI, 87 ~ 99),在肺栓塞方面分别为92% (95% CI, 71 ~ 98)和99% (95% CI, 83 ~ 100),在心脏填塞方面分别为100% (95% CI, 69 ~ 100)和100% (95% CI, 98 ~ 100)。证据的质量从极低到中等不等。结论:在极低到中等质量证据的基础上,POCUS在确定休克亚型和特定休克病因方面可能优于排除它们。即时超声是一种很有前途的诊断休克的工具。研究注册:PROSPERO (CRD42020160001);首次提交于2019年12月1日。
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来源期刊
CiteScore
8.50
自引率
7.10%
发文量
161
审稿时长
6-12 weeks
期刊介绍: The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.
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