Table 1.
Authora | Suspected condition | Study type | Main question | Nb | Decision rulea | Confirmation of diagnosis | Key findings |
---|---|---|---|---|---|---|---|
Buller 2009 [22] | DVT | Prospective management study | Diagnostic performance | 1002 | Oudega [9] | Ultrasonography + 3-month follow up | 49% ruled out; false negative rate 1.4% (95% CI 0.6–2.9%); 49% ruled in: 25% positive by ultrasonography |
Geersing 2010 [24] | DVT | Cross sectional survey | Clinical probability assessed by GP vs decision rule | 1002 | Oudega [9] | Ultrasonography + 3-month follow-up | False negative rate 3 and 7 in clinical probability and decision rule, respectively; more ruled out correctly: 493 vs 188 and 296 for clinical probability of 10% and 20% |
Van der Velde 2011 [25] | DVT | Post-hoc analysis | Comparison of Wells and Oudega rules | 1002 | Oudega [9] and Wells [32] | Ultrasonography + 3-month follow-up | 45% and 49% ruled out using Wells and Oudega rules, respectively; false negative rate: 1.7% and 1.4%, respectively |
Janssen 2011 [26] | DVT | Prospective study with updating tools | Impact of additional predictors to Oudega rule | 1002 | Oudega [9] | Ultrasonography + 3-month follow-up | Original diagnostic score not improved on Buller (22) findings |
Geersing 2012 [23] | PE | Prospective cohort/validation study | Diagnostic performance | 598 | Wells PE [20] | Composite imaging methods and independent adjudication committee | 45% rule out; false negative rate with a Wells score of ≤ 4 and negative D-dimer: 1.5% |
Lucassen 2015 [27] | PE | Post-hoc analysis | Comparison between qualitative and quantitative tests | 598 | Wells PE [20] | Composite imaging methods and independent adjudication committee | 45% and 42% rule out with qualitative and quantitative tests, respectively; false negative rates: 1.5% and 0.4%, respectively |
Hendriksen 2015 [28] | PE | Validation study | Comparison of decision rules | 598 | Three Wells and two Geneva | Composite imaging methods and independent adjudication committee | Sensitivity range 88–96% (simplified Wells); false negative range: 1.2% (simplified Wells) to 3.1% |
Schouton 2014 [29] | PE | Prospective cohort/validation study | Diagnostic performance of decision rule in an elderly population | 294c | Wells PE, and with age-related cut-offs [20] | Composite imaging methods + 3-month follow-up | 29% and 24% ruled out using Wells and revised rule, respectively; false negative rate 5.9% and 2.9%, respectively |
Bold type for authors of identified primary studies; remaining studies are based on data from primary study cohorts
It is important to note that all of the studies featured in this review employed the same qualitative lateral flow test, with a D-dimer cut-off value of 80 ng/mL
GP general practitioner
aReference in brackets
bNumber of patients where relevant data was available
cParticipants resided in a nursing home setting