Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis
Abstract Background Circulatory failure is classified into four types of shock (obstructive, cardiogenic, distributive, and hypovolemic) that must be distinguished as each requires a different treatment. Point-of-care ultrasound (POCUS) is widely used in clinical practice for acute conditions, and...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-05-01
|
| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04495-6 |
| _version_ | 1797817979179630592 |
|---|---|
| author | Takuo Yoshida Takuya Yoshida Hisashi Noma Takeshi Nomura Akihiro Suzuki Takahiro Mihara |
| author_facet | Takuo Yoshida Takuya Yoshida Hisashi Noma Takeshi Nomura Akihiro Suzuki Takahiro Mihara |
| author_sort | Takuo Yoshida |
| collection | DOAJ |
| description | Abstract Background Circulatory failure is classified into four types of shock (obstructive, cardiogenic, distributive, and hypovolemic) that must be distinguished as each requires a different treatment. Point-of-care ultrasound (POCUS) is widely used in clinical practice for acute conditions, and several diagnostic protocols using POCUS for shock have been developed. This study aimed to evaluate the diagnostic accuracy of POCUS in identifying the etiology of shock. Methods We conducted a systematic literature search of MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Clinicaltrial.gov, European Union Clinical Trials Register, WHO International Clinical Trials Registry Platform, and University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) until June 15, 2022. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed study quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was conducted to pool the diagnostic accuracy of POCUS for each type of shock. The study protocol was prospectively registered in UMIN-CTR (UMIN 000048025). Results Of the 1553 studies identified, 36 studies were full-text reviewed, and 12 studies with 1132 patients were included in the meta-analysis. Pooled sensitivity and specificity were 0.82 [95% confidence interval (CI) 0.68–0.91] and 0.98 [95% CI 0.92–0.99] for obstructive shock, 0.78 [95% CI 0.56–0.91] and 0.96 [95% CI 0.92–0.98] for cardiogenic shock, 0.90 [95% CI 0.84–0.94] and 0.92 [95% CI 0.88–0.95] for hypovolemic shock, and 0.79 [95% CI 0.71–0.85] and 0.96 [95% CI 0.91–0.98] for distributive shock, respectively. The area under the receiver operating characteristic curve for each type of shock was approximately 0.95. The positive likelihood ratios for each type of shock were all greater than 10, especially 40 [95% CI 11–105] for obstructive shock. The negative likelihood ratio for each type of shock was approximately 0.2. Conclusions The identification of the etiology for each type of shock using POCUS was characterized by high sensitivity and positive likelihood ratios, especially for obstructive shock. |
| first_indexed | 2024-03-13T09:01:30Z |
| format | Article |
| id | doaj.art-4f567b21e3e6417fbafa0beec3df2d61 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-13T09:01:30Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-4f567b21e3e6417fbafa0beec3df2d612023-05-28T11:18:07ZengBMCCritical Care1364-85352023-05-0127111110.1186/s13054-023-04495-6Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysisTakuo Yoshida0Takuya Yoshida1Hisashi Noma2Takeshi Nomura3Akihiro Suzuki4Takahiro Mihara5Department of Health Data Science, Graduate School of Data Science, Yokohama City UniversityDepartment of Health Data Science, Graduate School of Data Science, Yokohama City UniversityDepartment of Data Science, The Institute of Statistical MathematicsDepartment of Perioperative Medical Support, Tokushukai Medical CorporationDepartment of Anesthesiology and Critical Care Medicine, Jichi Medical UniversityDepartment of Health Data Science, Graduate School of Data Science, Yokohama City UniversityAbstract Background Circulatory failure is classified into four types of shock (obstructive, cardiogenic, distributive, and hypovolemic) that must be distinguished as each requires a different treatment. Point-of-care ultrasound (POCUS) is widely used in clinical practice for acute conditions, and several diagnostic protocols using POCUS for shock have been developed. This study aimed to evaluate the diagnostic accuracy of POCUS in identifying the etiology of shock. Methods We conducted a systematic literature search of MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Clinicaltrial.gov, European Union Clinical Trials Register, WHO International Clinical Trials Registry Platform, and University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) until June 15, 2022. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed study quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was conducted to pool the diagnostic accuracy of POCUS for each type of shock. The study protocol was prospectively registered in UMIN-CTR (UMIN 000048025). Results Of the 1553 studies identified, 36 studies were full-text reviewed, and 12 studies with 1132 patients were included in the meta-analysis. Pooled sensitivity and specificity were 0.82 [95% confidence interval (CI) 0.68–0.91] and 0.98 [95% CI 0.92–0.99] for obstructive shock, 0.78 [95% CI 0.56–0.91] and 0.96 [95% CI 0.92–0.98] for cardiogenic shock, 0.90 [95% CI 0.84–0.94] and 0.92 [95% CI 0.88–0.95] for hypovolemic shock, and 0.79 [95% CI 0.71–0.85] and 0.96 [95% CI 0.91–0.98] for distributive shock, respectively. The area under the receiver operating characteristic curve for each type of shock was approximately 0.95. The positive likelihood ratios for each type of shock were all greater than 10, especially 40 [95% CI 11–105] for obstructive shock. The negative likelihood ratio for each type of shock was approximately 0.2. Conclusions The identification of the etiology for each type of shock using POCUS was characterized by high sensitivity and positive likelihood ratios, especially for obstructive shock.https://doi.org/10.1186/s13054-023-04495-6Circulatory failureShockPoint-of-care ultrasoundDiagnostic accuracyObstructive shockEarly diagnosis |
| spellingShingle | Takuo Yoshida Takuya Yoshida Hisashi Noma Takeshi Nomura Akihiro Suzuki Takahiro Mihara Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis Critical Care Circulatory failure Shock Point-of-care ultrasound Diagnostic accuracy Obstructive shock Early diagnosis |
| title | Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis |
| title_full | Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis |
| title_fullStr | Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis |
| title_full_unstemmed | Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis |
| title_short | Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis |
| title_sort | diagnostic accuracy of point of care ultrasound for shock a systematic review and meta analysis |
| topic | Circulatory failure Shock Point-of-care ultrasound Diagnostic accuracy Obstructive shock Early diagnosis |
| url | https://doi.org/10.1186/s13054-023-04495-6 |
| work_keys_str_mv | AT takuoyoshida diagnosticaccuracyofpointofcareultrasoundforshockasystematicreviewandmetaanalysis AT takuyayoshida diagnosticaccuracyofpointofcareultrasoundforshockasystematicreviewandmetaanalysis AT hisashinoma diagnosticaccuracyofpointofcareultrasoundforshockasystematicreviewandmetaanalysis AT takeshinomura diagnosticaccuracyofpointofcareultrasoundforshockasystematicreviewandmetaanalysis AT akihirosuzuki diagnosticaccuracyofpointofcareultrasoundforshockasystematicreviewandmetaanalysis AT takahiromihara diagnosticaccuracyofpointofcareultrasoundforshockasystematicreviewandmetaanalysis |