![]() But all of the studies in the meta-analysis included asymptomatic patients only after orthopedic surgery. Wells et al performed a meta-analysis of patients after orthopedic surgery, and found that US had a low sensitivity of 62% for detecting proximal thrombi. The McMaster Diagnostic Imaging Practice Guidelines Initiative reported that US had a sensitivity of 97% for proximal DVT and 73% for distal DVT, and a specificity of 96%. Ultrasound (US) is widely recognized as a choice of the imaging methods for suspected DVT thanks to its noninvasiveness, low cost, ready availability, portability, safety, and operator-friendliness. Early accurate diagnosis is therefore essential to allow immediate treatment for avoiding potential consequences, such as pulmonary embolism and unnecessary anticoagulation treatment.Ĭontrast venography is accepted as the gold standard for the detection of DVT however, this technique has its own disadvantages due to extravasation of the contrast medium, systemic reactions to the contrast medium and venous thrombosis at the catheter site. DVT can occur in deep veins of the pelvis, thigh or calf, with the thrombus subsequently detaching as an embolus and lodging in the pulmonary vessels. It is estimated that Deep-vein thrombosis (DVT) has an incidence of approximately 1 in 1000 and leads to more than 50,000 deaths annually in the USA. Pure compression technique for DVT had a poor sensitivity of 43% (95% CI = 39%–48%), pure color/doppler technique for DVT had a pooled sensitivity of 58% (95% CI = 53%–63%), compression and color/doppler technique for DVT had a pooled sensitivity of 61% (95% CI = 48%–74%). Using venography as the gold standard, US for proximal DVT had a pooled sensitivity of 59% (95% confidence interval (CI) = 51%–66%) and a pooled specificity of 98% (95% CI = 97%–98%), US for distal DVT had a poor sensitivity of 43% (95% CI = 38%–48%) and a pooled specificity of 95% (95% CI = 94%–96%), US for whole-leg DVT had a pooled sensitivity of 59% (95% CI = 54%–64%) and a pooled specificity of 95% (95% CI = 94%–96%), US for post-major orthopedic surgery patients had a pooled sensitivity of 52% (95% CI = 49%–55%), and US for other types of patients had a pooled sensitivity of 58% (95% CI = 43%–72%). ![]() The meta-analysis included 26 articles containing 41 individual studies with a total of 3951 patients without symptoms of DVT. The study quality and the risk of bias were evaluated using QUADAS-2, with heterogeneity was assessed and quantified by the Q score and I 2 statistics, respectively. There were 4 different classes of subgroup analysis-the class of patients stratified by location of US exam (proximal, distal, whole leg), the class stratified by technique (color/doppler, compression, both modalities), the class stratified by kind of surgery (orthopedic, otherwise hospitalized) and the class stratified by era of publishing (1980s, 1990s, 2000s). A meta-analysis was performed using Meta-DiSc (version 1.4), providing the pooled sensitivity, specificity, positive (LR+) and negative (LR–) likelihood ratios of the detection accuracy of US. Full-text reports on prospective diagnostic studies involve the detection of lower-limb proximal and distal DVT in patients without symptoms of DVT using US and venography. The research team performed a systematic search in PubMed, Ovid, Cochrane, and Web of Science without language or date restrictions.
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