PDF(Pubmed)
Abstract：
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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
摘要：
背景：深静脉血栓形成（DVT）的评估在临床上很难诊断。DVT诊断的“黄金标准测试”是静脉造影；然而，在急诊科DVT评估中,已建议采用各种定点护理超声(POCUS)方案.
目的：本综述评估了不同POCUS方案在急诊科诊断DVT中的作用。
方法：根据PRISMA指南进行系统评价和荟萃分析，并在PROSEPRO（CRD42023398871）上注册。Embase中的电子数据库搜索，PubMed,ScienceDirect,和谷歌学者，并进行了手动搜索，以确定合格的研究，直到2023年2月。诊断准确性研究的质量评估工具（QUADAS-2）用于评估纳入研究的偏倚风险。使用STATA16和ReviewManager软件（RevMan5.4.1）进行定量分析。灵敏度,与参考标准试验相比,计算了用于DVT诊断的POCUS方案的特异性.
结果：在26项纳入的研究中发现了异质性。汇集的敏感性，特异性，PPV,2点POCUS方案的NPV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），分别。同样，汇集的敏感性，特异性，PPV,3点POCUS的净现值为89.15%(95%CI：83.24-95.07)，92.71%（95%CI：89.59-95.83），81.27%（95%CI：73.79-88.75），95.47%（95%CI：92.93-98）。数据汇集为完整的压缩超声，全腿双工超声的敏感性和特异性也为100％（95％CI：98.21-100）和97.05％（95％CI：92.25-100），分别。另一方面,急诊医师进行POCUS的分诊至DVT诊断的时间显著短于放射科医师进行的诊断检查.
结论：由急诊医师执行的POCUS方案的诊断性能非常好。结合到诊断的时间显著减少。POCUS可作为急诊DVT诊断的一线影像工具。我们还建议在DVT诊断期间出现接受POCUS培训的急诊主治医师，以提高诊断性能，即使在最少的培训下也能观察到高诊断性能。
目的：本综述评估了不同POCUS方案在急诊科诊断DVT中的作用。
方法：根据PRISMA指南进行系统评价和荟萃分析，并在PROSEPRO（CRD42023398871）上注册。Embase中的电子数据库搜索，PubMed,ScienceDirect,和谷歌学者，并进行了手动搜索，以确定合格的研究，直到2023年2月。诊断准确性研究的质量评估工具（QUADAS-2）用于评估纳入研究的偏倚风险。使用STATA16和ReviewManager软件（RevMan5.4.1）进行定量分析。灵敏度,与参考标准试验相比,计算了用于DVT诊断的POCUS方案的特异性.
结果：在26项纳入的研究中发现了异质性。汇集的敏感性，特异性，PPV,2点POCUS方案的NPV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），分别。同样，汇集的敏感性，特异性，PPV,3点POCUS的净现值为89.15%(95%CI：83.24-95.07)，92.71%（95%CI：89.59-95.83），81.27%（95%CI：73.79-88.75），95.47%（95%CI：92.93-98）。数据汇集为完整的压缩超声，全腿双工超声的敏感性和特异性也为100％（95％CI：98.21-100）和97.05％（95％CI：92.25-100），分别。另一方面,急诊医师进行POCUS的分诊至DVT诊断的时间显著短于放射科医师进行的诊断检查.
结论：由急诊医师执行的POCUS方案的诊断性能非常好。结合到诊断的时间显著减少。POCUS可作为急诊DVT诊断的一线影像工具。我们还建议在DVT诊断期间出现接受POCUS培训的急诊主治医师，以提高诊断性能，即使在最少的培训下也能观察到高诊断性能。
