Summary of results of studies informing sensitivity and specificity of tests for diagnosis of PE
| Test . | No. of participants (studies) . | Sensitivity (95% CI) . | Specificity (95% CI) . | Quality of evidence . |
|---|---|---|---|---|
| CTPA | 3 929 (15) | 0.93 (0.88-0.96) | 0.98 (0.96-0.99) | Moderate*,†,‡ |
| D-dimer | 20 568 (30) | 0.97 (0.96-0.98) | 0.39 (0.36-0.43) | Moderate*,†,§ |
| Age-adjusted D-dimer | 2 885 (1) | 0.99 (0.98-1.00) | 0.47(0.45-0.49) | High|| |
| Proximal ultrasound | 1 715 (7) | 0.49 (0.31-0.66) | 0.96 (0.95-0.98) | Low*,¶,# |
| VQ 1 | 3 994 (13) | 0.58 (0.50-0.66) | 0.98 (0.96-0.99) | Moderate*,†,** |
| VQ 2 | 3 994 (13) | 0.98 (0.95-0.99) | 0.36 (0.27-0.45) | Moderate*,†,†† |
| VQ 3 | 3 994 (13) | 0.96 (0.91-0.98) | 0.95 (0.89-0.98) | High*,†,‡,‡ |
| Test . | No. of participants (studies) . | Sensitivity (95% CI) . | Specificity (95% CI) . | Quality of evidence . |
|---|---|---|---|---|
| CTPA | 3 929 (15) | 0.93 (0.88-0.96) | 0.98 (0.96-0.99) | Moderate*,†,‡ |
| D-dimer | 20 568 (30) | 0.97 (0.96-0.98) | 0.39 (0.36-0.43) | Moderate*,†,§ |
| Age-adjusted D-dimer | 2 885 (1) | 0.99 (0.98-1.00) | 0.47(0.45-0.49) | High|| |
| Proximal ultrasound | 1 715 (7) | 0.49 (0.31-0.66) | 0.96 (0.95-0.98) | Low*,¶,# |
| VQ 1 | 3 994 (13) | 0.58 (0.50-0.66) | 0.98 (0.96-0.99) | Moderate*,†,** |
| VQ 2 | 3 994 (13) | 0.98 (0.95-0.99) | 0.36 (0.27-0.45) | Moderate*,†,†† |
| VQ 3 | 3 994 (13) | 0.96 (0.91-0.98) | 0.95 (0.89-0.98) | High*,†,‡,‡ |
CI, confidence interval; VQ 1, high probability scan interpreted as positive, low/nondiagnostic/normal scan interpreted as negative; VQ 2, high/low/nondiagnostic probability scan interpreted as positive, normal scan interpreted as negative; VQ 3, high probability scan interpreted as positive, normal scan interpreted as negative.
Certainty in evidence not downgraded for risk of bias, although few studies had a combination of reference standards that were judged to be acceptable by a panel of clinical experts.
Certainty in evidence was downgraded for indirectness in instances where this test was not the index test in a diagnostic pathway. There was a lack of data on the accuracy of this test following a previous test in a pathway. Thus, sensitivity and specificity used for modeling in these instances were based on the test accuracy of the individual test rather than using the test in a pathway.
Certainty in evidence was downgraded for serious unexplained inconsistency in sensitivity, with a range from 63% to 99.2%. Minor inconsistency for specificity noted but judged to be insufficient to downgrade the certainty in evidence.
Minor inconsistency for sensitivity noted but judged to be insufficient to downgrade the certainty in evidence. Certainty in evidence was downgraded for serious unexplained inconsistency in specificity, with a range from 12.8% to 64%.
Certainty in evidence not downgraded for imprecision given the large population size, although only 1 prospective age-adjusted D-dimer study was identified for analysis.
Certainty in evidence was downgraded for serious unexplained inconsistency in sensitivity, with a range from 18.4% to 96.7%. Minor inconsistency for specificity noted but judged to be insufficient to downgrade the certainty in evidence.
Certainty in evidence downgraded for indirectness because of lack of data on the accuracy of this test following a previous test in a pathway. Sensitivity and specificity used for modeling are based on the test accuracy of the individual test rather than using the test in a pathway.
Certainty in evidence was downgraded for serious unexplained inconsistency in sensitivity, with a range from 13.9% to 84.6%. Minor inconsistency for specificity noted but judged to be insufficient to downgrade the certainty in evidence.
Minor inconsistency for sensitivity noted but judged to be insufficient to downgrade the certainty in evidence. Certainty in evidence was downgraded for serious unexplained inconsistency in specificity, with a range from 10.9% to 81.8%.
‡‡Minor inconsistency for sensitivity and specificity noted but judged to be insufficient to downgrade the certainty in evidence.