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Clinical Method Applied to Focused Ultrasound: The Case of Wells’ Score and Echocardiography in the Emergency Department: A Systematic Review and a Meta-Analysis
- Source :
- Medicina, Vol 57, Iss 766, p 766 (2021), Medicina, Volume 57, Issue 8
- Publication Year :
- 2021
- Publisher :
- MDPI AG, 2021.
-
Abstract
- Background and Objectives: bedside cardiac ultrasound is a widely adopted method in Emergency Departments (ED) for extending physical examination and refining clinical diagnosis. However, in the setting of hemodynamically-stable pulmonary embolism, the diagnostic role of echocardiography is still the subject of debate. In light of its high specificity and low sensitivity, some authors suggest that echocardiographic signs of right ventricle overload could be used to rule-in pulmonary embolism. In this study, we aimed to clarify the diagnostic role of echocardiographic signs of right ventricle overload in the setting of hemodynamically-stable pulmonary embolism in the ED. Materials and Methods: we performed a systematic review of literature in PubMed, Web of Science and Cochrane databases, considering the echocardiographic signs for the diagnosis of pulmonary embolism in the ED. Studies considering unstable or shocked patients were excluded. Papers enrolling hemodynamically stable subjects were selected. We performed a diagnostic test accuracy meta-analysis for each sign, and then performed a critical evaluation according to pretest probability, assessed with Wells’ score for pulmonary embolism. Results: 10 studies were finally included. We observed a good specificity and a low sensitivity of each echocardiographic sign of right ventricle overload. However, once stratified by the Wells’ score, the post-test probability only increased among high-risk patients. Conclusions: signs of echocardiographic right ventricle overload should not be used to modify the clinical behavior in low- and intermediate- risk patients according to Wells’ score classification. Among high-risk patients, however, echocardiographic signs could help a physician in detecting patients with the highest probability of pulmonary embolism, necessitating a confirmation by computed tomography with pulmonary angiography. However, a focused cardiac and thoracic ultrasound investigation is useful for the differential diagnosis of dyspnea and chest pain in the ED.
- Subjects :
- Medicine (General)
medicine.medical_specialty
diagnosis
Physical examination
030204 cardiovascular system & hematology
Chest pain
Article
03 medical and health sciences
R5-920
0302 clinical medicine
medicine
Pulmonary angiography
Humans
Ultrasonography
medicine.diagnostic_test
Emergency department
business.industry
Pulmonary embolism
Angiography
030208 emergency & critical care medicine
General Medicine
medicine.disease
Pre- and post-test probability
Critical care
Echocardiography
Radiology
medicine.symptom
Differential diagnosis
Emergency Service, Hospital
business
Diagnosi
Subjects
Details
- ISSN :
- 16489144
- Volume :
- 57
- Database :
- OpenAIRE
- Journal :
- Medicina
- Accession number :
- edsair.doi.dedup.....545106e510490dab157c49fbee43bc9e