Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point-of-care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta-analysis

2017 ◽  
Vol 24 (5) ◽  
pp. 523-551 ◽  
Author(s):  
Roshanak Benabbas ◽  
Mark Hanna ◽  
Jay Shah ◽  
Richard Sinert
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Acute Appendicitis ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Laboratory Tests ◽  
Point Of Care ◽  
Meta Analysis ◽  
Point Of Care Ultrasound

scholarly journals The Accuracy and Prognostic Value of Point‐of‐care Ultrasound for Nephrolithiasis in the Emergency Department: A Systematic Review and Meta‐analysis

2018 ◽  
Vol 25 (6) ◽  
pp. 684-698 ◽  
Author(s):  
Charles Wong ◽  
Braden Teitge ◽  
Marshall Ross ◽  
Paul Young ◽  
Helen Lee Robertson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Prognostic Value ◽  
Point Of Care ◽  
Meta Analysis ◽  
Point Of Care Ultrasound

scholarly journals MP05: Diagnostic accuracy of point of care ultrasound in undifferentiated hypotension presenting to the emergency department: a systematic review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S43-S44 ◽  
Author(s):  
L. Richardson ◽  
O. Loubani ◽  
P. Atkinson
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Full Article ◽  
Diagnostic Accuracy ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Point Of Care ◽  
Initial Assessment ◽  
Point Of Care Ultrasound ◽  
Strong Conclusion

Introduction: Undifferentiated hypotension remains one of the most life-threatening presentations to emergency departments (ED) around the world. An accurate and rapid initial assessment is essential, as shock carries a high mortality with multiple unique etiologies and management plans. Point of care ultrasound (PoCUS) has emerged as a promising tool to improve these diagnostic and management challenges, yet its reliability in this setting remains unclear. Methods: We performed a systematic review of Medline, EMBASE, CINAHL, Cochrane, and clinicaltrials.gov databases from inception to June 8, 2018. Databases were reviewed by two independent researchers and all languages were included. The methodological quality of included studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Our primary outcome was diagnostic accuracy of PoCUS in hypotension, with secondary outcomes including patient outcomes and changes to management. Results: Our literature search revealed 5345 articles after duplicates were removed, leaving 235 articles for full article review. Following full article review, 9 studies remained and were included in the systematic review. There were 2 randomized control trials, 6 prospective cohort trials, and 1 retrospective cohort trial. For our primary outcome of diagnostic accuracy, eight studies were included; we extracted Kappa values ranging from 0.70 to 0.971, pooled sensitivity ranging from 69% to 88%, and pooled specificity ranging from 88% to 96%. Four studies reported on management change including results reporting shorter time to disposition, change in diagnostic test ordering (18% to 31%), change in consultation (13.6%), change in admission location (12%) and change in management plan (25% to 40%). Only one study reported on patient outcomes, which revealed no survival or length of stay benefit. Conclusion: When assessing for the diagnostic accuracy of PoCUS in the setting of undifferentiated hypotension presenting to the emergency department, we found fair consistency between PoCUS and final diagnosis with high Kappa values, fair to good pooled sensitivities, and good to excellent specificities. There was no strong evidence indicating improved outcomes. However, the large amount of heterogeneity amongst studies has limited our ability to make a strong conclusion except that future research should focus on a uniform study design and patient focused outcomes.

scholarly journals The diagnostic accuracy of a point-of-care ultrasound protocol for shock etiology: A systematic review and meta-analysis

CJEM ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 406-417 ◽  
Author(s):  
Sean P. Stickles ◽  
Christopher R. Carpenter ◽  
Robert Gekle ◽  
Chadd K. Kraus ◽  
Caryn Scoville ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Point Of Care ◽  
Meta Analysis ◽  
Hypovolemic Shock ◽  
Point Of Care Ultrasound ◽  
Cochrane Central Register ◽  
Study Quality ◽  
Obstructive Shock

ABSTRACTObjectiveThe aim of this study was to perform a systematic review and meta-analysis of the diagnostic accuracy of a point-of-care ultrasound exam for undifferentiated shock in patients presenting to the emergency department.MethodsOvid MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and research meeting abstracts were searched from 1966 to June 2018 for relevant studies. QUADAS-2 was used to assess study quality, and meta-analysis was conducted to pool performance data of individual categories of shock.ResultsA total of 5,097 non-duplicated studies were identified, of which 58 underwent full-text review; 4 were included for analysis. Study quality by QUADAS-2 was considered overall a low risk of bias. Pooled positive likelihood ratio values ranged from 8.25 (95% CI 3.29 to 20.69) for hypovolemic shock to 40.54 (95% CI 12.06 to 136.28) for obstructive shock. Pooled negative likelihood ratio values ranged from 0.13 (95% CI 0.04 to 0.48) for obstructive shock to 0.32 (95% CI 0.16 to 0.62) for mixed-etiology shock.ConclusionThe rapid ultrasound for shock and hypotension (RUSH) exam performs better when used to rule in causes of shock, rather than to definitively exclude specific etiologies. The negative likelihood ratios of the exam by subtype suggest that it most accurately rules out obstructive shock.

Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis from the SHoC investigators

Resuscitation ◽  
2019 ◽  
Vol 139 ◽  
pp. 159-166 ◽  
Author(s):  
Elizabeth Lalande ◽  
Talia Burwash-Brennan ◽  
Katharine Burns ◽  
Paul Atkinson ◽  
Michael Lambert ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Point Of Care ◽  
Meta Analysis ◽  
Point Of Care Ultrasound ◽  
Reliable Predictor

scholarly journals The diagnostic accuracy of isothermal nucleic acid point-of-care tests for human coronaviruses: A systematic review and meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Pakpoom Subsoontorn ◽  
Manupat Lohitnavy ◽  
Chuenjid Kongkaew
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Point Of Care ◽  
Meta Analysis ◽  
Isothermal Amplification ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Index Test ◽  
Point Of Care Tests

AbstractMany recent studies reported coronavirus point-of-care tests (POCTs) based on isothermal amplification. However, the performances of these tests have not been systematically evaluated. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy was used as a guideline for conducting this systematic review. We searched peer-reviewed and preprint articles in PubMed, BioRxiv and MedRxiv up to 28 September 2020 to identify studies that provide data to calculate sensitivity, specificity and diagnostic odds ratio (DOR). Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was applied for assessing quality of included studies and Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) was followed for reporting. We included 81 studies from 65 research articles on POCTs of SARS, MERS and COVID-19. Most studies had high risk of patient selection and index test bias but low risk in other domains. Diagnostic specificities were high (> 0.95) for included studies while sensitivities varied depending on type of assays and sample used. Most studies (n = 51) used reverse transcription loop-mediated isothermal amplification (RT-LAMP) to diagnose coronaviruses. RT-LAMP of RNA purified from COVID-19 patient samples had pooled sensitivity at 0.94 (95% CI: 0.90–0.96). RT-LAMP of crude samples had substantially lower sensitivity at 0.78 (95% CI: 0.65–0.87). Abbott ID Now performance was similar to RT-LAMP of crude samples. Diagnostic performances by CRISPR and RT-LAMP on purified RNA were similar. Other diagnostic platforms including RT- recombinase assisted amplification (RT-RAA) and SAMBA-II also offered high sensitivity (> 0.95). Future studies should focus on the use of un-bias patient cohorts, double-blinded index test and detection assays that do not require RNA extraction.

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