Table 12Ultrasound – Quality assessment

OutcomeNumber of studiesDesignLimitationsInconsistencyIndirectnessImprecision
Various ultrasound techniques – meta-analysis85
Sensitivity & Specificity98Meta- analysis of diagnostic cohortsNo serious limitationsNo serious inconsistencySerious indirectness (a)No serious imprecision
NPV & PPV98Meta- analysis of diagnostic cohortsNo serious limitationsNo serious inconsistencySerious indirectness (a)No serious imprecision
Various ultrasound techniques (studies conducted after HTA review)
Sensitivity & Specificity (c) 171,181,202,109,223,243,146DiagnosticSerious limitations (b)No serious inconsistencySerious indirectness (d)Serious imprecision (e)
NPV & PPV(c) 171,181,202,109,223,243,146DiagnosticSerious limitations (b)No serious inconsistencySerious indirectness (d)Serious imprecision (e)
a

Goodacre (2006)85 was a HTA review which included 100 cohorts. 22 cohorts had compression ultrasonography alone, 5 cohorts had colour Doppler alone, 16 had continuous-wave Doppler alone, 28 had duplex (compression and colour Doppler), 25 had triplex (compression, colour Doppler and continuous-wave Doppler) and 4 had other techniques. Due to a large variation in the type of patients included (meta-analysis also included asymptomatic patients, for example) and techniques used, the results may not be directly to each setting whether there recommendation is applied.

b

Various limitations in studies such as unclear whether investigators were blinded to the reference/index test and small sample size. In addition, some studies may have included convenience samples rather than consecutive patients. One study14 had reported by limbs rather than patients. Only 44 patients were included in the study.

c

Ricci (2004)202, Shiver (2010)223 undertook ultrasound of the proximal area, Aywak (2007)14, Naz (2005) 172 and Ricci (2004)202 undertook ultrasound of the whole-leg area and Tomkowski (2007)243 gave results for the proximal and distal areas of the leg.

d

Studies recruited patients who were suspected of PE 223 or had confirmed PE 181 rather than patients who were presenting with suspected DVT. In addition, one study recruited consecutive patients from a prophylaxis study 243 – a screening study rather than a study in patient with suspected DVT. Meta-regression analysis of the HTA meta-analysis suggested that sensitivity decreases in cohorts which are asymptomatic.

From: 5, Diagnosis of deep vein thrombosis

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Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet].
NICE Clinical Guidelines, No. 144.
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