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Abstract：
BACKGROUND: Acute chest syndrome (ACS) is a leading cause of death in patients with sickle cell disease. Lung ultrasound (LUS) is emerging as a point-of-care method to diagnose ACS, allowing for more rapid diagnosis in the ED setting and sparing patients from ionizing radiation exposure.
OBJECTIVE: What is the diagnostic accuracy of LUS for ACS diagnosis, using the current reference standard of chest radiography?
METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this systematic review and meta-analysis. Embase, MEDLINE, Web of Science, and Google Scholar were used to compile all relevant studies. Two reviewers screened the studies for inclusion in this review. Cases of discrepancy were resolved by a third reviewer. Meta-analyses were conducted using both metadta and midas STATA software packages to retrieve summary receiver operating characteristic curves, sensitivities, and specificities. Three reviewers scored the studies with QUADAS-2 for risk of bias assessment.
RESULTS: From a total of 713 unique studies retrieved, six studies were included in the final quantitative synthesis. Of these, five studies were in pediatric EDs. Two studies were conference abstracts and not published manuscripts. Data were available for 625 possible ACS cases (97% of cases in patients aged ≤ 21 years) and 95 confirmed ACS diagnoses (pretest probability of 15.2%). The summary sensitivity was 0.92 (95% CI, 0.68-0.98) and the summary specificity was 0.89 (95% CI, 0.69-0.97) with an area under the curve of the summary receiver operating characteristic curve of 0.96 (95% CI, 0.94-0.97).
CONCLUSIONS: LUS has excellent sensitivity and very good specificity for ACS diagnosis and may serve as an initial point-of-care test to facilitate rapid treatment of ACS and spare pediatric patients from ionizing radiation; however, further research is warranted to improve the generalizability to the adult sickle cell disease population.
OBJECTIVE: What is the diagnostic accuracy of LUS for ACS diagnosis, using the current reference standard of chest radiography?
METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this systematic review and meta-analysis. Embase, MEDLINE, Web of Science, and Google Scholar were used to compile all relevant studies. Two reviewers screened the studies for inclusion in this review. Cases of discrepancy were resolved by a third reviewer. Meta-analyses were conducted using both metadta and midas STATA software packages to retrieve summary receiver operating characteristic curves, sensitivities, and specificities. Three reviewers scored the studies with QUADAS-2 for risk of bias assessment.
RESULTS: From a total of 713 unique studies retrieved, six studies were included in the final quantitative synthesis. Of these, five studies were in pediatric EDs. Two studies were conference abstracts and not published manuscripts. Data were available for 625 possible ACS cases (97% of cases in patients aged ≤ 21 years) and 95 confirmed ACS diagnoses (pretest probability of 15.2%). The summary sensitivity was 0.92 (95% CI, 0.68-0.98) and the summary specificity was 0.89 (95% CI, 0.69-0.97) with an area under the curve of the summary receiver operating characteristic curve of 0.96 (95% CI, 0.94-0.97).
CONCLUSIONS: LUS has excellent sensitivity and very good specificity for ACS diagnosis and may serve as an initial point-of-care test to facilitate rapid treatment of ACS and spare pediatric patients from ionizing radiation; however, further research is warranted to improve the generalizability to the adult sickle cell disease population.
摘要：
背景：急性胸部综合征（ACS）是镰状细胞病（SCD）患者死亡的主要原因。肺部超声（LUS）正在成为诊断ACS的一种即时护理方法，允许在急诊室环境中进行更快速的诊断，并使患者免于电离辐射暴露。
目的：使用当前的胸部X线参考标准，LUS对ACS诊断的诊断准确性如何？
方法：本系统综述和荟萃分析遵循系统综述和荟萃分析指南的首选报告项目。Embase,MEDLINE,WebofScience,和谷歌学者被用来汇编所有相关的研究。两名审稿人筛选了这些研究，以纳入本综述。第三位审查人员解决了差异案件。使用metadta和midasSTATA软件包进行荟萃分析，以检索汇总的受试者工作特征曲线。敏感性，和特殊性。三名评论者对使用QUADAS-2的研究进行偏倚风险评估。
结果：从检索到的713项独特研究中，在最终的定量合成中包括6项研究。其中,5项研究在儿科急诊科进行。两项研究是会议摘要，而不是发表的手稿。数据可用于625例可能的ACS病例（年龄≤21岁的患者占病例的97％）和95例确诊的ACS诊断（测试前概率为15.2％）。汇总灵敏度为0.92（95％CI，0.68-0.98），汇总特异性为0.89（95％CI，0.69-0.97），汇总受试者工作特征曲线的曲线下面积为0.96（95％CI，0.94-0.97）。
结论：LUS对ACS的诊断具有极好的敏感性和非常好的特异性，可以作为初始的即时测试，以促进ACS的快速治疗，并使儿科患者免于电离辐射；然而，需要进一步研究以提高对成年SCD人群的普适性.
目的：使用当前的胸部X线参考标准，LUS对ACS诊断的诊断准确性如何？
方法：本系统综述和荟萃分析遵循系统综述和荟萃分析指南的首选报告项目。Embase,MEDLINE,WebofScience,和谷歌学者被用来汇编所有相关的研究。两名审稿人筛选了这些研究，以纳入本综述。第三位审查人员解决了差异案件。使用metadta和midasSTATA软件包进行荟萃分析，以检索汇总的受试者工作特征曲线。敏感性，和特殊性。三名评论者对使用QUADAS-2的研究进行偏倚风险评估。
结果：从检索到的713项独特研究中，在最终的定量合成中包括6项研究。其中,5项研究在儿科急诊科进行。两项研究是会议摘要，而不是发表的手稿。数据可用于625例可能的ACS病例（年龄≤21岁的患者占病例的97％）和95例确诊的ACS诊断（测试前概率为15.2％）。汇总灵敏度为0.92（95％CI，0.68-0.98），汇总特异性为0.89（95％CI，0.69-0.97），汇总受试者工作特征曲线的曲线下面积为0.96（95％CI，0.94-0.97）。
结论：LUS对ACS的诊断具有极好的敏感性和非常好的特异性，可以作为初始的即时测试，以促进ACS的快速治疗，并使儿科患者免于电离辐射；然而，需要进一步研究以提高对成年SCD人群的普适性.
