Academic Journal
Accuracy of physicians' intuitive risk estimation in the diagnostic management of pulmonary embolism: an individual patient data meta-analysis.
| Τίτλος: | Accuracy of physicians' intuitive risk estimation in the diagnostic management of pulmonary embolism: an individual patient data meta-analysis. |
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| Συγγραφείς: | van Maanen R; Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: r.vanmaanen@umcutrecht.nl., Martens ESL; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: https://twitter.com/ESLmartens., Takada T; Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan., Roy PM; Department of Emergency Medicine, Angers University Hospital; MitoVasc UMR CNRS 6015 - INSERM 1083, Université Angers, Angers; and French Clinical Research Infrastructure (F-CRIN) Network, INvestigation Network On Venous Thrombo-Embolism (INNOVTE), Saint-Etienne, France., de Wit K; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Emergency Medicine, Queen's University, Kingston, Canada., Parpia S; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Oncology, McMaster University, Hamilton, Canada., Kraaijpoel N; Department of Medicine, Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands., Huisman MV; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Wells PS; Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada., Le Gal G; Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada., Righini M; Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Freund Y; Sorbonne University, Emergency Department, Hopital Pitie-Salpêtrière, Assistance Publique-Hopitaux de Paris, Paris, France., Galipienzo J; Service of Anesthesiology, MD Anderson Cancer Center Madrid, Madrid, Spain., van Es N; Amsterdam UMC location University of Amsterdam, Department of Vascular Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands., Blom JW; Department of General Practice, Leiden University Medical Center, Leiden, the Netherlands., Moons KGM; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Rutten FH; Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., van Smeden M; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Klok FA; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Geersing GJ; Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Luijken K; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. |
| Πηγή: | Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2023 Oct; Vol. 21 (10), pp. 2873-2883. Date of Electronic Publication: 2023 May 30. |
| Τύπος έκδοσης: | Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: England NLM ID: 101170508 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1538-7836 (Electronic) Linking ISSN: 15387836 NLM ISO Abbreviation: J Thromb Haemost Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2023- : [New York] : Elsevier Original Publication: Oxford : Blackwell Pub. |
| Ιατρικοί όροι (MeSH): | Pulmonary Embolism*/diagnosis , Pulmonary Embolism*/epidemiology , Physicians*, Humans ; Sensitivity and Specificity ; Male ; Female |
| Περίληψη: | Background: In patients clinically suspected of having pulmonary embolism (PE), physicians often rely on intuitive estimation ("gestalt") of PE presence. Although shown to be predictive, gestalt is criticized for its assumed variation across physicians and lack of standardization. Objectives: To assess the diagnostic accuracy of gestalt in the diagnosis of PE and gain insight into its possible variation. Methods: We performed an individual patient data meta-analysis including patients suspected of having PE. The primary outcome was diagnostic accuracy of gestalt for the diagnosis of PE, quantified as risk ratio (RR) between gestalt and PE based on 2-stage random-effect log-binomial meta-analysis regression as well as gestalts' sensitivity and specificity. The variability of these measures was explored across different health care settings, publication period, PE prevalence, patient subgroups (sex, heart failure, chronic lung disease, and items of the Wells score other than gestalt), and age. Results: We analyzed 20 770 patients suspected of having PE from 16 original studies. The prevalence of PE in patients with and without a positive gestalt was 28.8% vs 9.1%, respectively. The overall RR was 3.02 (95% CI, 2.35-3.87), and the overall sensitivity and specificity were 74% (95% CI, 68%-79%) and 61% (95% CI, 53%-68%), respectively. Although variation was observed across individual studies (I2, 90.63%), the diagnostic accuracy was consistent across all subgroups and health care settings. Conclusion: A positive gestalt was associated with a 3-fold increased risk of PE in suspected patients. Although variation was observed across studies, the RR of gestalt was similar across prespecified subgroups and health care settings, exemplifying its diagnostic value for all patients suspected of having PE. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.) |
| Competing Interests: | Declaration of competing interests There are no competing interests to disclose. |
| Σχόλια: | Comment in: J Thromb Haemost. 2023 Oct;21(10):2702-2704. doi: 10.1016/j.jtha.2023.06.030.. (PMID: 37739587) |
| Contributed Indexing: | Keywords: diagnosis; pulmonary embolism; venous thromboembolism; venous thrombosis |
| Entry Date(s): | Date Created: 20230601 Date Completed: 20231002 Latest Revision: 20231227 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.jtha.2023.05.023 |
| PMID: | 37263381 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1538-7836 |
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| DOI: | 10.1016/j.jtha.2023.05.023 |