A Systematic Review of the Current State and Validity of Digital Assessment Tools for Psychiatry (Preprint)

BACKGROUND Given the role digital technologies are likely to play in the future of mental healthcare, there is a need for a comprehensive appraisal of the current state and validity (i.e., screening/diagnostic accuracy) of digital mental health assessments. OBJECTIVE To explore the current state and validity of question-and-answer-based digital tools for diagnosing and screening psychiatric conditions in adults. METHODS This systematic review was based on the Population, Intervention, Comparison, and Outcome (PICO) framework and was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase, Cochrane Library, ASSIA, Web of Science Core Collection, CINAHL, and PsycINFO were systematically searched for articles published between 2005 and 2020. A descriptive evaluation of the study characteristics and digital solutions and a quantitative appraisal of the screening/diagnostic accuracy of the included tools was conducted. Risk of bias and applicability were assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) guidelines. RESULTS A total of 25 studies met the inclusion criteria, with the most frequently evaluated conditions encompassing generalized anxiety disorder (GAD), major depressive disorder (MDD), and any depressive disorder. The majority of the studies employed digitized versions of existing pen-and-paper questionnaires, with findings revealing poor to excellent screening/diagnostic accuracy (sensitivity = 0.36-1.00, specificity = 0.37-1.00, AUC = 0.57-0.98) and a high risk of bias for most of the included studies. CONCLUSIONS The current state of the field of digital mental health tools is in its early stages and high-quality evidence is lacking. INTERNATIONAL REGISTERED REPORT RR2-10.2196/25382

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The Current State and Diagnostic Accuracy of Digital Mental Health Assessment Tools for Psychiatric Disorders: Protocol for a Systematic Review and Meta-analysis (Preprint)

10.2196/preprints.25382 ◽

2020 ◽

Author(s):

Nayra A Martin-Key ◽

Thea S Schei ◽

Eleanor J Barker ◽

Benedetta Spadaro ◽

Erin Funnell ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Diagnostic Accuracy ◽

Meta Analysis ◽

Adult Population ◽

Assessment Tools ◽

Cochrane Library ◽

Future Research ◽

Digital Assessment ◽

Question And Answer

BACKGROUND Despite the rapidly growing number of digital assessment tools for screening and diagnosing mental health disorders, little is known about their diagnostic accuracy. OBJECTIVE The purpose of this systematic review and meta-analysis is to establish the diagnostic accuracy of question- and answer-based digital assessment tools for diagnosing a range of highly prevalent psychiatric conditions in the adult population. METHODS The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) will be used. The focus of the systematic review is guided by the population, intervention, comparator, and outcome framework (PICO). We will conduct a comprehensive systematic literature search of MEDLINE, PsychINFO, Embase, Web of Science Core Collection, Cochrane Library, Applied Social Sciences Index and Abstracts (ASSIA), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for appropriate articles published from January 1, 2005. Two authors will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any inconsistencies will be discussed and resolved. The two authors will then extract data into a standardized form. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, and a descriptive analysis and meta-analysis will summarize the diagnostic accuracy of the identified digital assessment tools. RESULTS The systematic review and meta-analysis commenced in November 2020, with findings expected by May 2021. CONCLUSIONS This systematic review and meta-analysis will summarize the diagnostic accuracy of question- and answer-based digital assessment tools. It will identify implications for clinical practice, areas for improvement, and directions for future research. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42020214724; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020214724. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/25382

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The Current State and Diagnostic Accuracy of Digital Mental Health Assessment Tools for Psychiatric Disorders: Protocol for a Systematic Review and Meta-analysis

JMIR Research Protocols ◽

10.2196/25382 ◽

2021 ◽

Vol 10 (1) ◽

pp. e25382

Author(s):

Nayra A Martin-Key ◽

Thea S Schei ◽

Eleanor J Barker ◽

Benedetta Spadaro ◽

Erin Funnell ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Diagnostic Accuracy ◽

Meta Analysis ◽

Adult Population ◽

Assessment Tools ◽

Cochrane Library ◽

Future Research ◽

Digital Assessment ◽

Question And Answer

Background Despite the rapidly growing number of digital assessment tools for screening and diagnosing mental health disorders, little is known about their diagnostic accuracy. Objective The purpose of this systematic review and meta-analysis is to establish the diagnostic accuracy of question- and answer-based digital assessment tools for diagnosing a range of highly prevalent psychiatric conditions in the adult population. Methods The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) will be used. The focus of the systematic review is guided by the population, intervention, comparator, and outcome framework (PICO). We will conduct a comprehensive systematic literature search of MEDLINE, PsychINFO, Embase, Web of Science Core Collection, Cochrane Library, Applied Social Sciences Index and Abstracts (ASSIA), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for appropriate articles published from January 1, 2005. Two authors will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any inconsistencies will be discussed and resolved. The two authors will then extract data into a standardized form. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, and a descriptive analysis and meta-analysis will summarize the diagnostic accuracy of the identified digital assessment tools. Results The systematic review and meta-analysis commenced in November 2020, with findings expected by May 2021. Conclusions This systematic review and meta-analysis will summarize the diagnostic accuracy of question- and answer-based digital assessment tools. It will identify implications for clinical practice, areas for improvement, and directions for future research. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020214724; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020214724. International Registered Report Identifier (IRRID) DERR1-10.2196/25382

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Diagnostic value of transcranial ultrasonography for selecting subjects with large vessel occlusion: a systematic review

The Ultrasound Journal ◽

10.1186/s13089-019-0143-6 ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Daria Antipova ◽

Leila Eadie ◽

Ashish Stephen Macaden ◽

Philip Wilson

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Acute Stroke ◽

Clinical Assessment ◽

Assessment Tools ◽

Large Vessel ◽

Cochrane Library ◽

Direct Transfer ◽

Large Vessel Occlusion ◽

Vessel Occlusion

Abstract Introduction A number of pre-hospital clinical assessment tools have been developed to triage subjects with acute stroke due to large vessel occlusion (LVO) to a specialised endovascular centre, but their false negative rates remain high leading to inappropriate and costly emergency transfers. Transcranial ultrasonography may represent a valuable pre-hospital tool for selecting patients with LVO who could benefit from rapid transfer to a dedicated centre. Methods Diagnostic accuracy of transcranial ultrasonography in acute stroke was subjected to systematic review. Medline, Embase, PubMed, Scopus, and The Cochrane Library were searched. Published articles reporting diagnostic accuracy of transcranial ultrasonography in comparison to a reference imaging method were selected. Studies reporting estimates of diagnostic accuracy were included in the meta-analysis. Results Twenty-seven published articles were selected for the systematic review. Transcranial Doppler findings, such as absent or diminished blood flow signal in a major cerebral artery and asymmetry index ≥ 21% were shown to be suggestive of LVO. It demonstrated sensitivity ranging from 68 to 100% and specificity of 78–99% for detecting acute steno-occlusive lesions. Area under the receiver operating characteristics curve was 0.91. Transcranial ultrasonography can also detect haemorrhagic foci, however, its application is largely restricted by lesion location. Conclusions Transcranial ultrasonography might potentially be used for the selection of subjects with acute LVO, to help streamline patient care and allow direct transfer to specialised endovascular centres. It can also assist in detecting haemorrhagic lesions in some cases, however, its applicability here is largely restricted. Additional research should optimize the scanning technique. Further work is required to demonstrate whether this diagnostic approach, possibly combined with clinical assessment, could be used at the pre-hospital stage to justify direct transfer to a regional thrombectomy centre in suitable cases.

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A Systematic Review of the Current State and Validity of Digital Assessment Tools for Psychiatry (Preprint)

JMIR Mental Health ◽

10.2196/32824 ◽

2021 ◽

Author(s):

Nayra A Martin-Key ◽

Benedetta Spadaro ◽

Erin Funnell ◽

Eleanor Jane Barker ◽

Thea Sofie Schei ◽

...

Keyword(s):

Systematic Review ◽

Assessment Tools ◽

Digital Assessment ◽

Current State

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Does retirement trigger depressive symptoms? A systematic review and meta-analysis

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796021000627 ◽

2021 ◽

Vol 30 ◽

Author(s):

A. Odone ◽

V. Gianfredi ◽

G. P. Vigezzi ◽

A. Amerio ◽

C. Ardito ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Depressive Symptoms ◽

Protective Effect ◽

Meta Analysis ◽

Assessment Tools ◽

Cochrane Library ◽

High Quality ◽

Funnel Plot ◽

Funnel Plot Asymmetry

Abstract Aims Retirement is a major life transition that may improve or worsen mental health, including depression. Existing studies provide contradictory results. We conducted a systematic review with meta-analysis to quantitatively pool available evidence on the association of retirement and depressive symptoms. Methods We applied PRISMA guidelines to conduct a systematic review and meta-analysis to retrieve, quantitatively pool and critically evaluate the association between retirement and both incident and prevalent depression and to understand better the potential role of individual and contextual-level determinants. Relevant original studies were identified by searching PubMed, Embase, PsycINFO and the Cochrane Library, through 4 March 2021. Subgroup and sensitivity meta-analyses were conducted by gender, study design (longitudinal v. cross-sectional studies), study quality score (QS) and considering studies using validated scales to diagnose depression. Heterogeneity between studies was evaluated with I2 statistics. Results Forty-one original studies met our a priori defined inclusion criteria. Meta-analysis on more than half a million subjects (n = 557 111) from 60 datasets suggested a protective effect of retirement on the risk of depression [effect size (ES) = 0.83, 95% confidence interval (CI) = 0.74–0.93], although with high statistical heterogeneity between risk estimates (χ2 = 895.19, df = 59, I2 = 93.41%, p-value < 0.0001). Funnel plot asymmetry and trim and fill method suggested a minor potential publication bias. Results were consistent, confirm their robustness and suggest stronger protective effects when progressively restricting the included studies based on quality criteria: (i) studies with the highest QS [55 datasets, 407 086 subjects, ES = 0.81, 95% CI = 0.71–0.91], (ii) studies with a high QS and using validated assessment tools to diagnose depression (44 datasets, 239 453 subjects, ES = 0.76, 95% CI = 0.65–0.88) and (iii) studies of high quality, using a validated tool and with a longitudinal design (24 datasets, 162 004 subjects, ES = 0.76, 95% CI = 0.64–0.90). We observed a progressive reduction in funnel plot asymmetry. About gender, no statistically significant difference was found (females ES = 0.79, 95% CI = 0.61–1.02 v. men ES = 0.87, 95% CI = 0.68–1.11). Conclusions Pooled data suggested that retirement reduces by nearly 20% the risk of depression; such estimates got stronger when limiting the analysis to longitudinal and high-quality studies, even if results are affected by high heterogeneity. As retirement seems to have an independent and protective effect on mental health and depressive symptoms, greater flexibility in retirement timing should be granted to older workers to reduce their mental burden and avoid the development of severe depression. Retirement may also be identified as a target moment for preventive interventions, particularly primary and secondary prevention, to promote health and wellbeing in older ages, boosting the observed impact.

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Platelet-Rich Plasma Augmentation to Microfracture Provides a Limited Benefit for the Treatment of Cartilage Lesions: A Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120910504 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091050 ◽

Cited By ~ 4

Author(s):

Angelo Boffa ◽

Davide Previtali ◽

Sante Alessandro Altamura ◽

Stefano Zaffagnini ◽

Christian Candrian ◽

...

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Risk Of Bias ◽

Assessment Tools ◽

Cochrane Library ◽

Level Of Evidence ◽

Cartilage Lesions

Background: Microfracture is the most common first-line option for the treatment of small chondral lesions, although increasing evidence shows that the clinical benefit of microfracture decreases over time. Platelet-rich plasma (PRP) has been suggested as an effective biological augmentation to improve clinical outcomes after microfracture. Purpose: To evaluate the clinical evidence regarding the application of PRP, documenting safety and efficacy of this augmentation technique to improve microfracture for the treatment of cartilage lesions. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed in PubMed, EBSCOhost database, and the Cochrane Library to identify comparative studies evaluating the clinical efficacy of PRP augmentation to microfracture. A meta-analysis was performed on articles that reported results for visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC), and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Risk of bias was documented through use of the Cochrane Collaboration Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions assessment tools. The quality assessment was performed according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: A total of 7 studies met the inclusion criteria and were included in the meta-analysis: 4 randomized controlled trials, 2 prospective comparative studies, and 1 retrospective comparative study, for a total of 234 patients. Of the 7 studies included, 4 studies evaluated the effects of PRP treatment in the knee, and 3 studies evaluated effects in the ankle. The analysis of all scores showed a difference favoring PRP treatment in knees (VAS, P = .002 and P < .001 at 12 and 24 months, respectively; IKDC, P < .001 at both follow-up points) and ankles (both VAS and AOFAS, P < .001 at 12 months). The improvement offered by PRP did not reach the minimal clinically important difference (MCID). Conclusion: PRP provided an improvement to microfracture in knees and ankles at short-term follow-up. However, this improvement did not reach the MCID, and thus it was not clinically perceivable by the patients. Moreover, the overall low evidence and the paucity of high-level studies indicate further research is needed to confirm the potential of PRP augmentation to microfracture for the treatment of cartilage lesions.

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Diagnostic accuracy of focused deep venous, lung, cardiac and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis

Thorax ◽

10.1136/thoraxjnl-2021-216838 ◽

2021 ◽

pp. thoraxjnl-2021-216838

Author(s):

Casper Falster ◽

Niels Jacobsen ◽

Karen Ehlers Coman ◽

Mikkel Højlund ◽

Thomas Agerbo Gaist ◽

...

Keyword(s):

Systematic Review ◽

Pulmonary Embolism ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Risk Of Bias ◽

Endobronchial Ultrasound ◽

Cochrane Library ◽

Suspected Pulmonary Embolism ◽

Reference Test

ObjectiveTo determine the diagnostic accuracy of point-of-care ultrasound in suspected pulmonary embolism.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase, CINAHL and Cochrane library were searched on 2 July 2020 with no restrictions on the date of publication. Subject headings or subheadings combined with text words for the concepts of pulmonary embolism, ultrasound and diagnosis were used.Eligibility criteria and data analysisEligible studies reported sensitivity and specificity of deep venous, lung, cardiac or multiorgan ultrasound in patients with suspected pulmonary embolism, using an adequate reference-test. Prospective, cross-sectional and retrospective studies were considered for eligibility. No restrictions were made on language. Studies were excluded if a control group consisted of healthy volunteers or if transesophageal or endobronchial ultrasound was used. Risk of bias was assessed using quality assessment of diagnostic accuracy studies-2. Meta-analysis of sensitivity and specificity was performed by construction of hierarchical summary receiver operator curves. I2 was used to assess the study heterogeneity.Main outcome measuresThe primary outcome was overall sensitivity and specificity of reported ultrasound signs, stratified by organ approach (deep venous, lung, cardiac and multiorgan). Secondary outcomes were stratum-specific sensitivity and specificity within subgroups defined by pretest probability of pulmonary embolism.Results6378 references were identified, and 70 studies included. The study population comprised 9664 patients with a prevalence of pulmonary embolism of 39.9% (3852/9664). Risk of bias in at least one domain was found in 98.6% (69/70) of included studies. Most frequently, 72.8% (51/70) of studies reported >24 hours between ultrasound examination and reference test or did not disclose time interval at all. Level of heterogeneity ranged from 0% to 100%. Most notable ultrasound signs were bilateral compression of femoral and popliteal veins (22 studies; 4708 patients; sensitivity 43.7% (36.3% to 51.4%); specificity 96.7% (95.4% to 97.6%)), presence of at least one hypoechoic pleural-based lesion (19 studies; 2134 patients; sensitivity 81.4% (73.2% to 87.5%); specificity 87.4% (80.9% to 91.9%)), D-sign (13 studies; 1579 patients; sensitivity 29.7% (24.6% to 35.4%); specificity 96.2% (93.1% to 98.0%)), visible right ventricular thrombus (5 studies; 995 patients; sensitivity 4.7% (2.7% to 8.1%); specificity 100% (99.0% to 100%)) and McConnell’s sign (11 studies; 1480 patients; sensitivity 29.1% (20.0% to 40.1%); specificity 98.6% (96.7% to 99.4%)).ConclusionSeveral ultrasound signs exhibit a high specificity for pulmonary embolism, suggesting that implementation of ultrasound in the initial assessment of patients with suspected pulmonary embolism may improve the selection of patients for radiation imaging.PROSPERO registration numberCRD42020184313.

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A Protocol on Antimicrobial effectiveness of adjunctive disinfection techniques during root canal therapy in patients with pulp necrosis and apical periodontitis. A Systematic Review & Meta-analysis

10.21203/rs.2.19281/v1 ◽

2019 ◽

Author(s):

Durre Sadaf ◽

Zubair Ahmad ◽

Igho - Onakpoya

Keyword(s):

Systematic Review ◽

Root Canal ◽

Risk Of Bias ◽

Apical Periodontitis ◽

Assessment Tools ◽

Cochrane Library ◽

Root Canal Therapy ◽

Related Factors ◽

Mesh Terms ◽

Antimicrobial Effectiveness

Abstract Background The primary objective of root canal therapy is to eliminate bacteria from the root canal system of teeth. However, standard chemo-mechanical disinfection has been found unable to remove bacteria within the root canals. Clinicians tempted to use additional disinfection techniques to achieve adequate level of disinfection. There is no such systematic review that could comprehensively compare the efficiency of all currently used disinfection techniques. This systematic review aims to compare the antimicrobial effectiveness of various adjunctive disinfection techniques with standards chemo-mechanical disinfection technique(needle syringe irrigation) used during root canal therapy in patients with pulp necrosis and apical periodontitis.Methods A well-defined structured clinical question in the form of PICO (Patients/Problem, Intervention, Comparison, Outcome) is designed. The unit of analysis in this review is a tooth. Teeth with apical periodontitis is a problem (P). Interventions (I) are supplemental disinfection techniques that include photodynamic therapy, passive ultrasonic irrigation, and negative pressure techniques. Comparison (C) will be standard chemo-mechanical disinfection technique. Outcome (O) is the effectiveness of antimicrobial activity in the form of detection of bacteria and colony-forming units (CFU). Keywords, MeSH terms, and synonyms will be searched through previous literature, books, and Medline database. We will perform a comprehensive search strategy using electronic databases MEDLINE (Ovid), EMBASE (Ovid), and Cochrane library. Hand searching of top endodontic journals and reference lists of selected studies will be carried out. Selection of studies will be made under predefined inclusion and exclusion criteria. Data extraction of selected studies will be done with two reviewers using a structured data collection form. At the same time, the risk of bias using the Cochrane risk of bias assessment tools will be carried out. A qualitative and quantitative data synthesis will be done. The data will be presented in the form of tables of summary of findings.Discussion All potential clinical, methodological, and patient's related factors responsible for heterogeneity will be explored and discussed. We will also compare the results of our systematic review with existing literature. Strength and limitations of the systematic review will be discussed.Systematic Review registration Our protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO-CRD#42019099141).

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Diagnostic and prognostic accuracy of Protein C in adult patients with sepsis: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-050754 ◽

2021 ◽

Vol 11 (9) ◽

pp. e050754

Author(s):

Vanessa Catenacci ◽

Fatima Sheikh ◽

Kush Patel ◽

Alison Fox-Robichaud

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Protein C ◽

Data Extraction ◽

Meta Analysis ◽

Characteristic Curve ◽

Receiver Operator Characteristic Curve ◽

Risk Of Bias ◽

Cochrane Library ◽

Prognostic Accuracy

IntroductionSepsis is a dysregulated host response to infection characterised by activation of proinflammatory and procoagulant mechanisms. Protein C (PC)’s activity as an anticoagulant and antiinflammatory molecule makes it an appealing target for sepsis biomarker studies. To date, there has been no systematic review of PC as a sepsis biomarker.ObjectivesTo evaluate the diagnostic accuracy and prognostic strength of PC as a biomarker for adult sepsis.Methods and analysisMedline, Embase, Cochrane Library, PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from inception through 20 January 2021 for prospective observational studies that evaluate the use of PC as a diagnostic or prognostic biomarker for adult sepsis. Title and abstract screening, full-text screening and data extraction will be conducted in duplicate. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies and Quality in Prognostic Studies tools. If sufficient data are available, a meta-analysis will be conducted. The standardised mean difference and 95% CI will be calculated for prognostic and diagnostic studies. If possible, a hierarchical summary receiver operator characteristic curve will be generated to assess overall prognostic and diagnostic biomarker accuracy. I2 statistics will be used to assess heterogeneity. Sensitivity analysis will be performed by removing studies with a high risk of bias and re-examining the meta-analysis results.Ethics and disseminationGiven this is a systematic review and meta-analysis, there is no requirement for ethics approval. Findings will be disseminated through a peer-reviewed publication and social media.PROSPERO registration numberCRD42021229786.

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Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis

Critical Care ◽

10.1186/s13054-020-03358-8 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Akira Kuriyama ◽

Jeffrey L. Jackson ◽

Jun Kamei

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Airway Obstruction ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Leak Test ◽

Airway Complications ◽

Cuff Leak

Abstract Background Clinical practice guidelines recommend performing a cuff leak test in mechanically ventilated adults who meet extubation criteria to screen those at high risk for post-extubation stridor. Previous systematic reviews demonstrated excellent specificity of the cuff leak test but disagreed with respect to sensitivity. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the cuff leak test for predicting post-extubation airway complications in intubated adult patients in critical care settings. Methods We searched Medline, EMBASE, Scopus, ISI Web of Science, the Cochrane Library for eligible studies from inception to March 16, 2020, without language restrictions. We included studies that examined the diagnostic accuracy of cuff leak test if post-extubation airway obstruction after extubation or reintubation was explicitly reported as the reference standard. Two authors in duplicate and independently assessed the risk of bias using the Quality Assessment for Diagnostic Accuracy Studies-2 tool. We pooled sensitivities and specificities using generalized linear mixed model approach to bivariate random-effects meta-analysis. Our primary outcomes were post-extubation airway obstruction and reintubation. Results We included 28 studies involving 4493 extubations. Three studies were at low risk for all QUADAS-2 risk of bias domains. The pooled sensitivity and specificity of cuff leak test for post-extubation airway obstruction were 0.62 (95% CI 0.49–0.73; I2 = 81.6%) and 0.87 (95% CI 0.82–0.90; I2 = 97.8%), respectively. The pooled sensitivity and specificity of the cuff leak test for reintubation were 0.66 (95% CI 0.46–0.81; I2 = 48.9%) and 0.88 (95% CI 0.83–0.92; I2 = 87.4%), respectively. Subgroup analyses suggested that the type of cuff leak test and length of intubation might be the cause of statistical heterogeneity of sensitivity and specificity, respectively, for post-extubation airway obstruction. Conclusions The cuff leak test has excellent specificity but moderate sensitivity for post-extubation airway obstruction. The high specificity suggests that clinicians should consider intervening in patients with a positive test, but the low sensitivity suggests that patients still need to be closely monitored post-extubation.

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