| Literature DB >> 32227213 |
Meha Bhatt1, Cody Braun2, Payal Patel3, Parth Patel4, Housne Begum1, Wojtek Wiercioch1, Jamie Varghese4, David Wooldridge4, Hani J Alturkmani4, Merrill Thomas4, Mariam Baig4, Waled Bahaj4, Rasha Khatib5, Rohan Kehar6, Rakesh Ponnapureddy4, Anchal Sethi4, Ahmad Mustafa4, Robby Nieuwlaat1, Wendy Lim7,8, Shannon M Bates9, Eddy Lang10, Grégoire Le Gal11, Marc Righini12, Nedaa M Husainat13, Mohamad A Kalot13, Yazan Nayif Al Jabiri14, Holger J Schünemann1,7, Reem A Mustafa1,13.
Abstract
Deep vein thrombosis (DVT) of the lower extremities can be associated with significant morbidity and may progress to pulmonary embolism and postthrombotic syndrome. Early diagnosis and treatment are important to minimize the risk of these complications. We systematically reviewed the accuracy of diagnostic tests for first-episode and recurrent DVT of the lower extremities, including proximal compression ultrasonography (US), whole leg US, serial US, and high-sensitivity quantitative D-dimer assays. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 43 studies. For any suspected DVT, the pooled estimates for sensitivity and specificity of proximal compression US were 90.1% (95% confidence interval [CI], 86.5-92.8) and 98.5% (95% CI, 97.6-99.1), respectively. For whole-leg US, pooled estimates were 94.0% (95% CI, 91.3-95.9) and 97.3% (95% CI, 94.8-98.6); for serial US pooled estimates were 97.9% (95% CI, 96.0-98.9) and 99.8% (95% CI, 99.3-99.9). For D-dimer, pooled estimates were 96.1% (95% CI, 92.6-98.0) and 35.7% (95% CI, 29.5-42.4). Recurrent DVT studies were not pooled. Certainty of evidence varied from low to high. This systematic review of current diagnostic tests for DVT of the lower extremities provides accuracy estimates. The tests are evaluated when performed in a stand-alone fashion, and in a diagnostic pathway. The pretest probability of DVT often assessed by a clinical decision rule will influence how, together with sensitivity and specificity estimates, patients will be managed.Entities:
Mesh：
Year: 2020 PMID： 32227213 PMCID： PMC7160276 DOI： 10.1182/bloodadvances.2019000960
Source DB: PubMed Journal: Blood Adv ISSN： 2473-9529