Miriam Berenguer-Pérez, Nerea Manzanaro-García, Héctor González-de la Torre, Iván Durán-Sáenz, Elvira Hernández Martínez-Esparza, Miguel Ángel Diaz Herrera, Borja González Suárez, José Verdú-Soriano
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Our search included the PubMed, CINAHL, Scopus and Web of Science databases, and we assessed the risk of bias using the QUADAS-2 tool. A meta-analysis was conducted on polymerase chain reaction (PCR) and colorimetric methods to determine sensitivity, specificity, diagnostic odds ratio, and summary receiver-operating characteristic (sROC) curves using a random-effects model. For methods not suitable for quantitative synthesis, a narrative synthesis was performed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Nineteen studies involving various types of chronic wounds were analysed, revealing diverse diagnostic methods including fluorescence, PCR, colorimetry, voltammetry, electronic nose, biosensors, enzymatic methods, staining and microscopy. Combining fluorescence with clinical signs and symptoms (CSS) versus culture showed significant accuracy. Colorimetry demonstrated low sensitivity but high specificity, with a diagnostic odds ratio of 6.3. 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引用次数: 0
摘要
目的：本研究旨在评估检测慢性伤口微生物的非培养基方法的诊断准确性：我们系统地回顾了评估慢性伤口样本中替代检测方法诊断准确性的研究，排除了针对动物样本或无关情况的研究。检索范围包括 PubMed、CINAHL、Scopus 和 Web of Science 数据库，并采用 QUADAS-2 工具进行偏倚风险评估。我们的检索包括 PubMed、CINAHL、Scopus 和 Web of Science 数据库，并使用 QUADAS-2 工具评估了偏倚风险。我们对聚合酶链式反应（PCR）和比色法进行了荟萃分析，使用随机效应模型确定了灵敏度、特异性、诊断几率比例和接受者工作特征曲线（sROC）。对于不适合定量综合的方法，则进行了叙述性综合：分析了 19 项涉及各种类型慢性伤口的研究，发现了多种诊断方法，包括荧光、PCR、比色法、伏安法、电子鼻、生物传感器、酶法、染色法和显微镜法。将荧光与临床症状和体征（CSS）以及培养相结合，显示出显著的准确性。比色法的灵敏度较低，但特异性较高，诊断几率比为 6.3。聚合酶链反应（PCR）总体上表现出良好的准确性，但即使在亚组分析中也存在显著的异质性：本研究确定了多种诊断方法，突出了微生物分析与临床评估相结合所获得的卓越诊断准确性。然而，不同研究之间的异质性和方法差异给荟萃分析带来了挑战。未来的研究应以标准化和同质化的研究设计为目标，以加强对替代方法诊断准确性的评估。
Systematic review and meta-analysis of diagnostic test accuracy in chronic wound's microbiology
Purpose
This study aims to assess the diagnostic accuracy of non-culture-based methodologies for detecting microorganisms in chronic wounds.
Methods
We systematically reviewed studies that evaluated the diagnostic accuracy of alternative tests in chronic wound samples, excluding studies focused on animal samples or unrelated conditions. The search encompassed PubMed, CINAHL, Scopus and Web of Science databases, employing the QUADAS-2 tool for risk of bias assessment. Our search included the PubMed, CINAHL, Scopus and Web of Science databases, and we assessed the risk of bias using the QUADAS-2 tool. A meta-analysis was conducted on polymerase chain reaction (PCR) and colorimetric methods to determine sensitivity, specificity, diagnostic odds ratio, and summary receiver-operating characteristic (sROC) curves using a random-effects model. For methods not suitable for quantitative synthesis, a narrative synthesis was performed.
Results
Nineteen studies involving various types of chronic wounds were analysed, revealing diverse diagnostic methods including fluorescence, PCR, colorimetry, voltammetry, electronic nose, biosensors, enzymatic methods, staining and microscopy. Combining fluorescence with clinical signs and symptoms (CSS) versus culture showed significant accuracy. Colorimetry demonstrated low sensitivity but high specificity, with a diagnostic odds ratio of 6.3. PCR generally exhibited good accuracy, although significant heterogeneity was noted, even in subgroup analyses.
Conclusions
This study identified a broad spectrum of diagnostic approaches, highlighting the superior diagnostic accuracy achieved when microbiological analysis is combined with clinical assessments. However, the heterogeneity and methodological variations across studies present challenges in meta-analysis. Future research should aim for standardized and homogeneous study designs to enhance the assessment of diagnostic accuracy for alternative methods.
期刊介绍：
The Editors welcome papers on all aspects of prevention and treatment of wounds and associated conditions in the fields of surgery, dermatology, oncology, nursing, radiotherapy, physical therapy, occupational therapy and podiatry. The Journal accepts papers in the following categories:
- Research papers
- Review articles
- Clinical studies
- Letters
- News and Views: international perspectives, education initiatives, guidelines and different activities of groups and societies.
Calendar of events
The Editors are supported by a board of international experts and a panel of reviewers across a range of disciplines and specialties which ensures only the most current and relevant research is published.
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