Diagnosis of deep vein thrombosis of the upper extremity: A systematic review and meta-analysis of test accuracy

Payal Patel, Cody Braun, Parth Patel, Meha Bhatt, Housne Begum, Wojtek Wiercioch, Jamie Varghese, David Wooldridge, Hani J. Alturkmani, Merrill Thomas, Mariam Baig, Waled Bahaj, Rasha Khatib, Rohan Kehar, Rakesh Ponnapureddy, Anchal Sethi, Ahmad Mustafa, Wendy Lim, Grégoire Le Gal, Shannon M. BatesEddy Lang, Marc Righini, Nedaa M. Husainat, Mohamad A. Kalot, Yazan Nayif Al Jabiri, Robby Nieuwlaat, Holger J. Schünemann, Reem A. Mustafa

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


Upper extremity deep vein thrombosis (UEDVT) accounts for ≤10% of DVT and can be associated with morbidity and mortality. Accurate diagnosis and treatment are necessary for safe and effective patient management. We systematically reviewed the accuracy of D-dimer and duplex ultrasonography (US) for the evaluation of suspected first-episode UEDVT. We searched the Cochrane Central Register, OVID MEDLINE, EMBASE, and PubMed for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included prospective cross-sectional and cohort studies that evaluated test accuracy. Two investigators independently screened and collected data. The 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 9 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.96 (95% confidence interval [CI], 0.87-0.99) and 0.47 (95% CI, 0.43-0.52), respectively. The pooled estimates for duplex US sensitivity and specificity were 0.87 (95% CI, 0.73-0.94) and 0.85 (95% CI, 0.72-0.93), respectively. Certainty of evidence was moderate. In this review, we summarized the test accuracy (sensitivity and specificity) of D-dimer and duplex US for this indication. The sensitivity and specificity of the tests found in the present review should be considered in the context of whether they are used alone or in combination, which is dependent on the prevalence of disease in the population, the clinical setting in which the patient is being evaluated, cost, potential harms, and patient outcomes.

Original languageEnglish
Pages (from-to)2516-2522
Number of pages7
JournalBlood Advances
Issue number11
StatePublished - Jun 9 2020


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