scholarly journals Systematic Review and Meta‐analysis of Outcomes of Patients With Subsegmental Pulmonary Embolism With and Without Anticoagulation Treatment

2018 ◽  
Vol 25 (7) ◽  
pp. 828-835 ◽  
Author(s):  
Adam Bariteau ◽  
Lauren K. Stewart ◽  
Thomas W. Emmett ◽  
Jeffrey A. Kline
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Meta Analysis ◽  
Anticoagulation Treatment

scholarly journals Deep learning for pulmonary embolism detection on computed tomography pulmonary angiogram: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shelly Soffer ◽  
Eyal Klang ◽  
Orit Shimon ◽  
Yiftach Barash ◽  
Noa Cahan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Deep Learning ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Future Research ◽  
Learning Models ◽  
Summary Receiver Operating Characteristic ◽  
Pulmonary Angiogram

AbstractComputed tomographic pulmonary angiography (CTPA) is the gold standard for pulmonary embolism (PE) diagnosis. However, this diagnosis is susceptible to misdiagnosis. In this study, we aimed to perform a systematic review of current literature applying deep learning for the diagnosis of PE on CTPA. MEDLINE/PUBMED were searched for studies that reported on the accuracy of deep learning algorithms for PE on CTPA. The risk of bias was evaluated using the QUADAS-2 tool. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curves were plotted. Seven studies met our inclusion criteria. A total of 36,847 CTPA studies were analyzed. All studies were retrospective. Five studies provided enough data to calculate summary estimates. The pooled sensitivity and specificity for PE detection were 0.88 (95% CI 0.803–0.927) and 0.86 (95% CI 0.756–0.924), respectively. Most studies had a high risk of bias. Our study suggests that deep learning models can detect PE on CTPA with satisfactory sensitivity and an acceptable number of false positive cases. Yet, these are only preliminary retrospective works, indicating the need for future research to determine the clinical impact of automated PE detection on patient care. Deep learning models are gradually being implemented in hospital systems, and it is important to understand the strengths and limitations of these algorithms.

scholarly journals Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism

2020 ◽  
Vol 4 (18) ◽  
pp. 4296-4311
Author(s):  
Parth Patel ◽  
Payal Patel ◽  
Meha Bhatt ◽  
Cody Braun ◽  
Housne Begum ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Pulmonary Angiography ◽  
Evaluation Framework ◽  
Test Accuracy ◽  
Assessment Development ◽  
Life Threatening ◽  
D Dimer

Abstract Pulmonary embolism (PE) is a common, potentially life-threatening yet treatable condition. Prompt diagnosis and expeditious therapeutic intervention is of paramount importance for optimal patient management. Our objective was to systematically review the accuracy of D-dimer assay, compression ultrasonography (CUS), computed tomography pulmonary angiography (CTPA), and ventilation-perfusion (V/Q) scanning for the diagnosis of suspected first and recurrent PE. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. 2 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 61 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.97 (95% confidence interval [CI], 0.96-0.98) and 0.41 (95% CI, 0.36-0.46) respectively, whereas CTPA sensitivity and specificity were 0.94 (95% CI, 0.89-0.97) and 0.98 (95% CI, 0.97-0.99), respectively, and CUS sensitivity and specificity were 0.49 (95% CI, 0.31-0.66) and 0.96 (95% CI, 0.95-0.98), respectively. Three variations of pooled estimates for sensitivity and specificity of V/Q scan were carried out, based on interpretation of test results. D-dimer had the highest sensitivity when compared with imaging. CTPA and V/Q scans (high probability scan as a positive and low/non-diagnostic/normal scan as negative) both had the highest specificity. This systematic review was registered on PROSPERO as CRD42018084669.

scholarly journals P142: Diagnosis of pulmonary embolism in the Canadian context: clinical review findings from a health technology assessment

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S107-S107
Author(s):  
A. Sinclair ◽  
K. Peprah ◽  
T. Quay ◽  
S. Mulla ◽  
L. Weeks
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Diagnostic Imaging ◽  
Laboratory Testing ◽  
Meta Analysis ◽  
Health Technology ◽  
Clinical Prediction ◽  
Prediction Rules ◽  
Canadian Context ◽  
D Dimer

Introduction: Pulmonary embolism (PE) is a diagnostic challenge, since it shares symptoms with other conditions. Missed diagnosis puts patients at a risk of a potentially fatal outcome, while false positive results leave them at risk of side effects (bleeding) from unnecessary treatment. Diagnosis involves a multi-step pathway consisting of clinical prediction rules (CPRs), laboratory testing, and diagnostic imaging, but the best strategy in the Canadian context is unclear. Methods: We carried out a systematic review of the diagnostic accuracy, clinical utility, and safety of diagnostic pathways, CPRs, and diagnostic imaging for the diagnosis of PE. Clinical prediction rules were studied by an overview of systematic reviews, and pathways and diagnostic imaging by a primary systematic review. Where feasible, a diagnostic test meta-analysis was conducted, with statistical adjustment for the use of variable and imperfect reference standards across studies. Results: The Wells CPR rule showed greater specificity than the Geneva, but the relative sensitivities were undetermined. Application of a CPR followed by with D-dimer laboratory testing can safely rule out PE. In diagnostic test accuracy meta-analysis, computed tomography (CT) (sensitivity 0.973, 95% CrI 0.921 to 1.00) and ventilation/perfusion single-photon emission CT (VQ-SPECT) (sensitivity 0.974, 95% CrI 0.898 to 1.00) had the highest sensitivity) and CT the highest specificity (0.987, 95% CrI 0.958 to 1.00). VQ and VQ-SPECT had a higher proportion of indeterminate studies, while VQ and VQ-SPECT involved lower radiation exposure than CT. Conclusion: CPR and D-dimer testing can be used to avoid unnecessary imaging. CT is the most accurate single modality, but radiation risk must be assessed. These findings, in conjunction with a recent health technology assessment, may help to inform clinical practice and guidelines.

scholarly journals The net benefit of thrombolysis in the management of intermediate risk pulmonary embolism: Systematic review and meta‐analysis

eJHaem ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. 457-466
Author(s):  
Pedro E. Alcedo ◽  
Herney Andrés García‐Perdomo ◽  
Cristhiam M. Rojas‐Hernandez
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Meta Analysis ◽  
Intermediate Risk ◽  
Net Benefit

Diagnostic Accuracy of Dual-Energy CT in Detection of Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 084653712090206 ◽  
Author(s):  
Waleed Abdellatif ◽  
Mahmoud Ahmed Ebada ◽  
Souad Alkanj ◽  
Ahmed Negida ◽  
Nicolas Murray ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Pulmonary Embolism ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Acute Pulmonary Embolism ◽  
Meta Analysis ◽  
Dual Energy ◽  
Dual Energy Computed Tomography ◽  
Sensitivity Specificity

Purpose: In this systematic review and meta-analysis, we aimed to investigate the accuracy of dual-energy computed tomography (DECT) in the detection of acute pulmonary embolism (PE). Methods: We searched Medline (via PubMed), EBSCO, Web of Science, Scopus, and the Cochrane Library for relevant published studies. We selected studies assessing the accuracy of DECT in the detection of PE. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 tool. Meta-analysis was performed to calculate mean estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). The summary receiver operating characteristic (sROC) curve was drawn to get the Cochran Q-index and the area under the curve (AUC). Results: Seven studies were included in our systematic review. Of the 182 patients included, 108 patients had PEs. The pooled analysis showed an overall sensitivity and specificity of 88.9% (95% confidence interval [CI]: 81.4%-94.1%) and 94.6% (95% CI: 86.7%-98.5%), respectively. The pooled PLR was 8.186 (95% CI: 3.726-17.986), while the pooled NLR was 0.159 (95% CI: 0.093-0.270). Cochran-Q was 0.8712, and AUC was 0.935 in the sROC curve. Conclusion: Dual-energy computed tomography shows high sensitivity, specificity, and diagnostic accuracy in the detection of acute PE. The high PLR highlights the high clinical importance of DECT as a prevalence-independent, rule-in test. Studies with a larger sample size with standardized reference tests are still needed to increase the statistical power of the study and support these findings.

scholarly journals THE VALUE OF ELECTROCARDIOGRAPHY FOR THE PROGNOSTICATION OF ACUTE PULMONARY EMBOLISM: A SYSTEMATIC REVIEW AND META-ANALYSIS

2016 ◽  
Vol 67 (13) ◽  
pp. 830 ◽  
Author(s):  
Amro Qaddoura ◽  
Genevieve Digby ◽  
Conrad Kabali ◽  
Piotr Kukla ◽  
Zhong-Qun Zhan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Meta Analysis
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