深静脉血栓 (DVT) 诊断:从急诊护理点超声波 (PoCUS) 技术中汲取灵感:系统综述和荟萃分析。

IF 3.4 Q2 Medicine
Hany A Zaki, Bilal Albaroudi, Eman E Shaban, Mohamed Elgassim, Nood Dhafi Almarri, Kaleem Basharat, Ahmed Shaban
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引用次数: 0

摘要

背景:深静脉血栓(DVT)的评估在临床上很难诊断。深静脉血栓诊断的 "金标准检测 "是静脉造影;然而,在急诊科评估深静脉血栓时,有各种护理点超声(POCUS)方案被推荐使用:方法:根据 PRISMA 指南进行系统回顾和荟萃分析,并在 PROSEPRO(CRD42023398871)上注册。在 Embase、PubMed、ScienceDirect 和 Google scholar 等电子数据库中进行了检索,并进行了人工检索,以确定截至 2023 年 2 月符合条件的研究。诊断准确性研究质量评估工具(QUADAS-2)用于评估纳入研究的偏倚风险。使用 STATA 16 和 Review Manager 软件(RevMan 5.4.1)进行定量分析。计算了 POCUS 诊断深静脉血栓方案与参考标准测试相比的敏感性和特异性:26项纳入研究之间存在异质性。2点POCUS方案的集合敏感性、特异性、PPV和NPV分别为92.32%(95% CI:87.58-97.06)、96.86%(95% CI:95.09-98.64)、88.41%(95% CI:82.24-94.58)和97.25%(95% CI:95.51-98.99)。同样,3 点 POCUS 的集合敏感性、特异性、PPV 和 NPV 分别为 89.15%(95% CI:83.24-95.07)、92.71%(95% CI:89.59-95.83)、81.27%(95% CI:73.79-88.75)和 95.47%(95% CI:92.93-98)。对完全压迫超声波和全腿双相超声波的数据进行汇总后,其敏感性和特异性也分别达到了 100%(95% CI:98.21-100)和 97.05%(95% CI:92.25-100)。另一方面,与放射科医生进行的诊断测试相比,急诊医生进行的 POCUS 测试从分诊到确诊深静脉血栓的时间明显更短:结论:由急诊医生实施的 POCUS 诊断方案诊断效果极佳。结论:由急诊医生执行的 POCUS 方案诊断效果极佳,而且诊断时间明显缩短。POCUS 可作为急诊科诊断深静脉血栓的一线成像工具。我们还建议,在诊断深静脉血栓时,受过 POCUS 培训的急诊主治医师应在场,以提高诊断效果,即使受过最低限度的培训,也能观察到很高的诊断效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Deep venous thrombosis (DVT) diagnostics: gleaning insights from point-of-care ultrasound (PoCUS) techniques in emergencies: a systematic review and meta-analysis.

Background: The assessment of deep venous thrombosis (DVT) is clinically difficult diagnosis. The "gold standard test" for DVT diagnosis is venography; however, various point-of-care ultrasound (POCUS) protocols have been suggested for DVT evaluation in the emergency department.

Aims: This review evaluated the role of different POCUS protocols in diagnosing DVT in the emergency department.

Methods: A systematic review and meta-analysis was conducted based of PRISMA guideline and registered on PROSEPRO (CRD42023398871). An electronic database search in Embase, PubMed, ScienceDirect, and Google scholar and a manual search were performed to identify eligible studies till February 2023. Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) was used to assess the risk of bias in included studies. Quantitative analysis was carried out using STATA 16 and Review Manager software (RevMan 5.4.1). Sensitivity, specificity of POCUS protocols for DVT diagnosis compared to reference standard test was calculated.

Results: Heterogeneity was identified between 26 included studies for review. The pooled sensitivity, specificity, PPV, and NPV for the 2-point POCUS protocol were 92.32% (95% CI: 87.58-97.06), 96.86% (95% CI: 95.09-98.64), 88.41% (95% CI: 82.24-94.58) and 97.25% (95% CI: 95.51-98.99), respectively. Similarly, the pooled sensitivity, specificity, PPV, and NPV for 3-point POCUS were 89.15% (95% CI: 83.24-95.07), 92.71% (95% CI: 89.59-95.83), 81.27% (95% CI: 73.79-88.75), and 95.47% (95% CI: 92.93-98). The data pooled for complete compression ultrasound, and whole-leg duplex ultrasound also resulted in a sensitivity and specificity of 100% (95% CI: 98.21-100) and 97.05% (95% CI: 92.25-100), respectively. On the other hand, the time from triage to DVT diagnosis was significantly shorter for emergency physician-performed POCUS than diagnostic tests performed by radiologists.

Conclusion: The diagnostic performance of POCUS protocols performed by emergency physicians was excellent. Combined with the significant reduction in time to diagnosis. POCUS can be used as the first-line imaging tool for DVT diagnosis in the emergency department. We also recommended that attending emergency physicians with POCUS training are present during DVT diagnosis to improve diagnostic performance even though high diagnostic performance is observed even with the minimum training.

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来源期刊
Ultrasound Journal
Ultrasound Journal Health Professions-Radiological and Ultrasound Technology
CiteScore
6.80
自引率
2.90%
发文量
45
审稿时长
22 weeks
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