Early diagnosis for pulmonary embolism: A systematic review and meta-analysis

The incidence of acute pulmonary embolism (APE) (especially early diagnosis) has increased annually in recent years, but the diagnosis of APE is a great challenge for every clinician. However, few studies have evaluated multiple diagnostic indicators simultaneously.

A systematic search was performed using CNKI, Wan fang data, VIP, PubMed and Web of Science for studies on the diagnosis of pulmonary embolism published up to October 31, 2022. Using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), we evaluated the risk of bias in included studies, and used a random-effects meta-analysis to obtain the summary sensitivity and specificity. The data that were extracted and calculated for this study included the first author, year of publication, country, study type, sample size, disease type, gold standard, diagnostic indicators and 4-compartment table data. We strictly followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review.

This study included 30 articles with a total sample size of 8947 cases, involving 4 detection methods: D-dimer, Geneva rules, Wells rules, and lung imaging. The combined effect size showed that lung imaging had the highest diagnostic value (SEN = 0.95, SPE = 0.89), followed by D-dimer (SEN = 0.92, SPE = 0.60), Geneva rules (SEN = 0.78, SPE = 0.68), and Wells rules (SEN = 0.77, SPE = 0.67). The area of lung imaging was largest under the Summary Receiver Operator Characteristic (SROC) curve (AUC = 0.97), followed by Geneva rules (AUC = 0.80), Wells rules (AUC = 0.79), and D-dimer (AUC = 0.74).

All 4 detection methods showed good ability to diagnose PE, and lung imaging was the best. Clinical trials are recommended to build an early decision-making model for the diagnosis of pulmonary embolism in order to increase the detection rate and improve prognosis.