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Table 3 Summary of findings

From: The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis

Review question: What is the diagnostic accuracy of cardiac ultrasound for the diagnosis of myocardial ischemia in patients with chest pain in the ED?

Population: Adults patients with chest pain. Some studies excluded patients with previous HD or low/high risk of coronary disease

Setting: Emergency Department

Study design: Prospective cohort studies, cross-sectional

Index test: Cardiac ultrasound (TTE, Limited TTE, POCUS)

Target Condition: Any Myocardial Ischemia (Myocardial infarction, ACS, Critical coronary Stenosis)

Reference Standards: Any reference standard (Final chart review, combination of tests, coronary angiogram or cardiac enzymes)

Limitations in the evidence

High risk of bias and applicability concerns, mainly driven by patient selection (exclusion of patients with HD, low or high risk of myocardial ischemia and patients with difficult ultrasound window) and by reference standard (lack of blinding and reference standard not correctly classifying the disease)

• Patient selection: High or unclear risk of bias in 26 (90%) studies; high or unclear concern of applicability in 21 (72%) studies

• Index test: Low risk of bias in 28 (97%) of studies, one with unclear risk of bias; high or unclear concern of applicability in 19 (66%) studies

• Reference Standard: High or unclear risk of bias in 27 (93%) studies; high or unclear concern of applicability in 25 (86%) studies

• Flow and timing: High or unclear risk of bias in 21 (72%) studies

Overall assessment: Most studies were at risk of bias (90%) and had concerns regarding applicability (90%)

Findings

Numer of studies (Participants)

Median proportion with target condition % (IQR)

Summary sensitivity % (95% confidence interval)

Summary specificity % (95% confidence interval)

GRADE Certainty of Evidencea

29

5043

26.9

(15.2–53.2)

79.3

(69.0–86.8)

87.3

(79.9–92.2)

⨁◯◯◯

Very low

  1. In a virtual population of 1000 patients with chest pain in the ED, assuming a prevalence of 27%, 270 patients will have acute myocardial ischemia. Of these, cardiac ultrasound will detect 214 patients with myocardial ischemia, but 56 patients will be missed (false negatives). For the 730 patients without the target condition, 93 patients will wronly diagnosed with myocardial ischemia (false positives)
  2. ED Emergency department; TTE trasnthoracic echocardiography; ACS acute coronary syndrome; EKG electrocardiogram; IQR Interquartile range, HD Heart Disease
  3. a GRADE approach was used for the assessment of certainty of evidence: Risk of bias was rated very serious, because 90% of studies had a high risk of bias in one or more QUADAS-2 domains, indirectness was rated very serious because 90% of studies had high concerns of applicability in one or more QUADAS-2 domains, inconsistency was rated not serious becasue substantial heterogeneity was explained by patient spectrum, timing of ultrasound reference standard and target condition, imprecision was rated serious for sensitiviy and not serious for specificity. No publication bias was detected
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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

ISSN: 1757-7241