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Optimal Strategies for the Diagnosis of Acute Pulmonary Embolism: A Health Technology Assessment — Project Protocol [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Sep 29. (CADTH Optimal Use Report, No. 6.3a.)

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Optimal Strategies for the Diagnosis of Acute Pulmonary Embolism: A Health Technology Assessment — Project Protocol [Internet].

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APPENDIX 6SELECTION CRITERIA FOR NETWORK META-ANALYSIS

Population
Q2 and 3: Adult patients undergoing testing for acute PEa
Patient subgroups of interest:
  • Pregnant women
  • Patients presenting for treatment at centres with access to imaging versus without access to imaging
  • Emergency room patients versus in-patients (secondary or tertiary care)
InterventionsComparators (or Reference Standards)
Any of the following imaging studies (± clinical decision rule ± biochemical or imaging-based risk stratification strategiesb)
  • CT technologiesc
  • MRI technologies
  • V/Q-based technologiesd
  • PET-CT
  • Thoracic ultrasound (+ echocardiography)
Q2 and 3A:
  • Composite reference standard (must include advanced diagnostic imaging tests [e.g., multidetector CT])
Q2 and 3 A, B, and C:

Any alternative diagnostic imaging exam (± clinical decision rule ± biochemical or imaging-based risk stratification strategies)
Outcomese
Q2 and 3:
  1. Diagnostic test accuracy (i.e., sensitivity, specificity, PPV, NPV, PLR, NLR, DOR, AUROC, Youden’s Index
  2. Clinical utility (failure rate [i.e., morbidity and mortality due to misdiagnosis at 30 days’ follow-up],f efficiency,g identification of patients with different diagnoses, change in referring physician’s diagnostic thinking, change in patient management, change in patient outcomes)
  3. Harms (safety outcomes of imaging procedures [e.g., radiation exposure, CT-attributed malignancy, contrast nephropathy, patient discomfort, allergic reactions])
Study design
  1. Diagnostic test accuracy outcomes: RCTs and non-randomized studies (i.e., controlled clinical trials, cohort studies, and cross-sectional studies)
  2. Clinical utility outcomes: RCTs and non-randomized studies (i.e., controlled clinical trials, cohort studies, controlled before-and-after studies, and case-control studies)
  3. Safety outcomes: in addition to the above study designs, non-randomized studies without a control group (excluding non-sequential case series and case reports) will also be included
Timeframe
Publications within the last 10 years (i.e., between January 2006 and September 2016)

± = with or without; AUROC = area under the receiver operating curve; CT = computed tomography; CTV/CTA = computed tomographic angiography in combination with venous-phase imaging; DOR = diagnostic odds ratio; DVT = deep vein thrombosis; MRI = magnetic resonance imaging; NLR = negative likelihood ratio; NPV = negative predictive value; PE = pulmonary embolism; PET-CT = positron emission tomography – computed tomography; PLR = positive likelihood ratio; PPV = positive predictive value; RCT = randomized controlled trial; SPECT = single-photon emission computed tomography; V/Q = ventilation-perfusion; VTE = venous thromboembolism.

a

Excluding pediatric patients, patients with recurrent VTE, and patients with suspected DVT.

b

Leg compression US, capnography, electrocardiography, echocardiography, chest radiograph.

c

Excluding single-detector, including CTA/CTV and triple-rule-out CT.

d

Including planar V/Q scan, V/Q SPECT, V/Q SPECT-CT.

e

No restriction on length of follow-up.

f

The proportion of patients classified as having low risk of PE who receive an ultimate diagnosis of PE based on the reference standard (false-negatives/true-negatives + false-negatives).

g

The proportion of patients in the study cohort stratified to the group with low predicted probability of PEs (sum of true and false-negatives/total cohort).

Copyright © 2016 CADTH.

The copyright and other intellectual property rights in this document are owned by CADTH and its licensors. These rights are protected by the Canadian Copyright Act and other national and international laws and agreements. Users are permitted to make copies of this document for non-commercial purposes only, provided it is not modified when reproduced and appropriate credit is given to CADTH and its licensors.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Bookshelf ID: NBK395889
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