A Systematic Review of Diagnostic Tests for Pulmonary Embolism

pulmonary embolism,diagnostic test,meta-analysis,systematic review,Science Journals

Objective To assess diagnostic tests for pulmonary thromboembolism(PTE) systematically so as to provide decision-making evidence for clinical screening and diagnosis.Materials and methods The electronic databases were searched,including Chinese Biomedicine Database(CBM),CNKI,MEDLINE,Cochrane Library,and CEBM/CCD.We handsearched the data from the references of all included studies,Chinese journals related to diagnosis and the proceeding of correlated conferences.Criteria for inclusion and exclusion were established according to validity criteria for diagnostic research published by the Cochrane Methods Group on Screening and Diagnostic Tests.The studies meeting the inclusion criteria were selected,and their methodological quality was assessed.Data of these studies were extracted via the data extraction form.Heterogeneity of the included articles was tested,which was used to select appropriate effect model to calculate pooled odds ratio,likelihood ratio,predictive value,and the according 95% confidence intervals.Summary receiver operating characteristic curve was performed and the area under the curve was calculated.Finally,sensitivity analysis was performed.Statistical analysis was performed with SPSS and RevMan 4.2 software.Results Twenty-one articles of 385 retrieved articles were included,with a total of twenty-two studies,including positive computed tomography pulmonary angiography(CTPA),positive magnetic resonance imaging(MRI),high probability ventilation/perfusion scanning and positive leg vein doppler vascular ultrasound the pooled indexes of diagnostic performance of positive MRI was higher than the others.In patients with a high pretest probability,these findings were associated with a positive predictive value(PPV) greater than 85% of pulmonary embolism.The rest findings were associated with a PPV of pulmonary embolism below 85%.But some results had no statistical significance(P0.05).The results of sensitivity analysis were consistent with the above.Conclusions Based on the systematic review of current eligible clinical trials,there aren't enough available evidences to support the selection of which test would be the best for diagnosis or screen the pulmonary embolism.MRI may be regarded as an effective and feasible diagnostic test for pulmonary embolism.Conclusions of meta-analysis will be displaced if the methodology of diagnostic test has been improved.