TY - JOUR
T1 - Diagnosis of deep vein thrombosis of the lower extremity
T2 - A systematic review and meta-analysis of test accuracy
AU - Bhatt, Meha
AU - Braun, Cody
AU - Patel, Payal
AU - Patel, Parth
AU - Begum, Housne
AU - Wiercioch, Wojtek
AU - Varghese, Jamie
AU - Wooldridge, David
AU - Alturkmani, Hani J.
AU - Thomas, Merrill
AU - Baig, Mariam
AU - Bahaj, Waled
AU - Khatib, Rasha
AU - Kehar, Rohan
AU - Ponnapureddy, Rakesh
AU - Sethi, Anchal
AU - Mustafa, Ahmad
AU - Nieuwlaat, Robby
AU - Lim, Wendy
AU - Bates, Shannon M.
AU - Lang, Eddy
AU - Le Gal, Grégoire
AU - Righini, Marc
AU - Husainat, Nedaa M.
AU - Kalot, Mohamad A.
AU - Al Jabiri, Yazan Nayif
AU - Schünemann, Holger J.
AU - Mustafa, Reem A.
N1 - Publisher Copyright:
© 2020 by The American Society of Hematology
PY - 2020/4/14
Y1 - 2020/4/14
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85083692657&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2019000960
DO - 10.1182/bloodadvances.2019000960
M3 - Review article
C2 - 32227213
AN - SCOPUS:85083692657
SN - 2473-9529
VL - 4
SP - 1250
EP - 1264
JO - Blood Advances
JF - Blood Advances
IS - 7
ER -