title: Role of Transthoracic Lung Ultrasonography in the Diagnosis of Pulmonary Embolism: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Pulmonary embolism (PE) is a potentially life-threatening condition. Although computed tomography pulmonary angiography (CTPA) is the reference standard for diagnosis, its early diagnosis remains a challenge, and the concerns about the radiation exposures further limit the general use of CTPA. The primary aim of this meta-analysis was to evaluate the overall diagnostic accuracy of transthoracic lung ultrasound (TLS) in the diagnosis of PE.
  
  
  METHODS
  PubMed, Web of science, OvidSP, ProQuest, EBSCO, Cochrane Library and Clinicaltrial.gov were searched systematically. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and hierarchical summary receiver operating characteristic (HSROC) curves were used to examine the TS performance. The Bayes analysis was used to calculate the post-test probability of PE. Publication bias was assessed with Deeks funnel plot.
  
  
  RESULTS
  The results indicated that the sensitivity, specificity, PLR and NLR were 0.85 (95% confidence interval (CI), 0.78 to 0.90), and 0.83 (95% CI, 0.73 to 0.90). And the DOR and HSROC were 28.82 (95% CI, 17.60 to 47.21), 0.91(95% CI, 0.88, 0.93).
  
  
  CONCLUSIONS
  The present meta-analysis suggested that transthoracic lung ultrasonography is helpful in diagnosing pulmonary embolism. Although the application of transthoracic lung ultrasound may change some patients' diagnostic processes, it is inappropriate to generally use transthoracic ultrasonography in diagnosing pulmonary embolism currently.
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China; China Emergency and Critical Care Evidence-based Group, Hangzhou, China.
authors.forename: Libing
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China; China Emergency and Critical Care Evidence-based Group, Hangzhou, China.
authors.forename: Yuefeng
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Changwei
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Weifeng
authors.initials: W
authors.lastname: Shen
authors.affiliation: China Emergency and Critical Care Evidence-based Group, Hangzhou, China; Department of respiration, The Third People's Hospital of Hangzhou,Hangzhou, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Feng
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Yongan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China; China Emergency and Critical Care Evidence-based Group, Hangzhou, China.
authors.forename: Mao
authors.initials: M
authors.lastname: Zhang
mesh_terms: D001499:Bayes Theorem; D006801:Humans; D017594:Publication Bias; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012372:ROC Curve; D014463:Ultrasonography / Q000379:methods*