急诊环境下床旁超声诊断下肢近端深静脉血栓的诊断准确性：系统综述与荟萃分析。
完整摘要 · 中文译文
目的评价急诊临床医生实施的超声对近端下肢深静脉血栓形成（DVT）的诊断准确性，并探讨不同扫描方案和操作者组别间的差异。方法本系统综述和荟萃分析纳入在急诊环境下疑似DVT的成人研究。检索PubMed、Embase、Cochrane Library和Web of Science核心合集，检索时间自建库至2026年4月8日，并在修订期间进行了截至2026年9月20日的针对性文献更新。采用双变量二项随机效应模型联合估计灵敏度和特异度。主要分析每项研究纳入一个数据集，以避免配对队列的重复加权。采用QUADAS-2评估偏倚风险和适用性。方案和操作者亚组分析为探索性分析。本综述已在PROSPERO注册（CRD420261361599）。结果16项研究提供了定量数据，因一个配对队列同时采用两点法和三点法方案评估，共提供17个方案数据集。从该配对队列中选择三点法结果进入主要总体模型，得到16个独立研究数据集，包括2，781例患者或肢体/检查单位。合并灵敏度为0.91（95%置信区间[CI] 0.85-0.95），特异度为0.95（95% CI 0.91-0.97）。两点法和三点法/扩展方案的灵敏度估计分别为0.87和0.92。对源数据不确定性进行了检查，包括Jahanian 2019中重建的诊断分析表和Crowhurst的临时输入数据。 在敏感性分析中进行挖掘。Koylu 2026 是在修订阶段针对性文献更新期间添加的。结论急诊临床医生实施的超声可在明确的诊断路径内支持近端深静脉血栓（DVT）评估。阴性的局限检查需结合临床概率与检查充分性进行解读。异质性和未解决的源数据限制了对合并估计值的置信度。探索性亚组发现不能确立任何方案或操作者组的优越性。
完整摘要 · 英文原文
ObjectiveTo evaluate the diagnostic accuracy of emergency clinician-performed ultrasound for proximal lower-extremity deep vein thrombosis (DVT) and explore variation by scan protocol and operator group.MethodsThis systematic review and meta-analysis included studies of adults with suspected DVT in emergency settings. PubMed, Embase, the Cochrane Library, and Web of Science Core Collection were searched from inception to 8 April 2026, and a targeted literature update was conducted through 20 September 2026 during revision. A bivariate binomial random-effects model jointly estimated sensitivity and specificity. The primary analysis included one dataset per study to avoid duplicate weighting of paired cohorts. Risk of bias and applicability were assessed with QUADAS-2. Protocol and operator subgroup analyses were exploratory. The review was registered in PROSPERO (CRD420261361599).ResultsSixteen studies contributed quantitative data, providing 17 protocol datasets because one paired cohort was evaluated with both two-point and three-point protocols. Selecting the three-point result from that paired cohort for the primary overall model yielded 16 independent study datasets comprising 2,781 patient or limb/examination units. Pooled sensitivity was 0.91 (95% confidence interval [CI] 0.85-0.95), and specificity was 0.95 (95% CI 0.91-0.97). Sensitivity estimates for two-point and three-point/extended protocols were 0.87 and 0.92, respectively. Source-data uncertainties, including a reconstructed diagnostic-analysis table in Jahanian 2019 and a provisional Crowhurst input, were examined in sensitivity analyses. Koylu 2026 was added during the revision-stage targeted literature update.ConclusionsEmergency clinician-performed ultrasound may support proximal DVT assessment within a defined diagnostic pathway. Negative limited examinations require interpretation alongside clinical probability and examination adequacy. Heterogeneity and unresolved source data limit confidence in the pooled estimates. Exploratory subgroup findings do not establish the superiority of any protocol or operator group.