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Published on: August 24, 2019
Performance of multiple case-finding approaches in detecting chronic obstructive pulmonary disease: a systematic
Dongru Du1, Sike He2, Shujin Guo3
1Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China; State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China.
Objectives:
To explore and compare the diagnostic performance of multiple case-finding approaches in screening for chronic obstructive pulmonary disease (COPD).
Study Design:
Systematic review and network meta-analysis.
Methods:
Records from PubMed, Embase, Web of Science and Scopus were screened to identify eligible studies. A direct meta-analysis was performed to evaluate the pooled sensitivity, specificity and area under curve (AUC) of each questionnaire. An additional network meta-analysis was subsequently conducted to perform network comparisons. The surface under the cumulative ranking (SUCRA) was also conducted to rank all screening methods according to sensitivity and specificity, respectively.
Results:
A total of 31 studies with 70,693 participants covering 11 screening approaches were included in this meta-analysis. The COPD diagnostic questionnaire (CDQ) reached the highest sensitivity (0.78, 95%CI 0.70, 0.84) and AUC (0.76, 95%CI 0.72, 0.79) among all approaches in the direct meta-analysis. In the network meta-analysis, the sensitivity rankings of all screening approaches based on SUCRA were: CDQ (83.9) > CAPTURE (62.3) > IPAG (58.0) > PUMA (52.8) > COPD-PS + PEF (52.3) > COPD-PS (49.1) > COPD-SQ (41.1) > COPD-SQ + PEF (33.6) > LFQ (33.5) > CAPTURE + PEF (24.9) > COLA-6 (8.6). The specificity rankings were: COLA-6 (75.8) > COPD-SQ + PEF (75.3) > PUMA (56.7) > CAPTURE + PEF (55.6) > COPD-PS (47.9) > LFQ (42.7) > COPD-PS + PEF (41.7) > COPD-SQ (38.3) > IPAG (33.0) > CDQ (25.7) > CAPTURE (7.3).
Conclusions:
CDQ, CAPTURE, and IPAG ranked the three highest in terms of sensitivity, whereas COLA-6, COPD-SQ combined with PEF, and PUMA ranked the three highest in terms of specificity. Further studies are still needed to explore effective COPD screening strategies in different settings.
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