Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis
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To assess the diagnostic accuracy of computed tomography (CT) angiography in the evaluation of patients with an episode of acute gastrointestinal haemorrhage.
Systematic review and meta-analysis to estimate pooled accuracy indices. A bivariate random effects model was adjusted to obtain a summary receiver-operating characteristic (sROC) curve and the corresponding area under the curve (AUC).
Twenty-two studies were included and provided data on 672 patients (range of age 5–74) with a mean age of 65 years. The overall sensitivity of CT angiography for detecting active acute GI haemorrhage was 85.2 % (95 % CI 75.5 % to 91.5 %). The overall specificity of CT angiography was 92.1 % (95 % CI 76.7 % to 97.7 %). The likelihood ratios for positive and negative test results were 10.8 (95 % CI 3.4 to 34.4) and 0.16 (95 % CI 0.1 to 0.27) respectively, with an AUC of 0.935 (95 % CI 0.693 to 0.989). The sources of heterogeneity explored had no significant impact on diagnostic performance.
CT shows high diagnostic accuracy and is an excellent diagnostic tool for detection and localising of intestinal bleeding sites. It is highly available, provides fast detection and localisation of the bleeding site, and is minimally invasive.
• CT angiography is increasingly used for investigating severe gastrointestinal bleeding.
• This systematic review and meta-analysis updates previous ones.
• In patients with massive gastrointestinal bleeding, CT angiography/MDCT detects bleeding accurately.
• CT angiography is useful in locating the bleeding site and determining appropriate treatment.
KeywordsGastrointestinal haemorrhage CT angiography Sensitivity and specificity Systematic review Meta-analysis
Multi-detector computed tomography
Summary receiver-operating characteristic
Area under the curve
Diagnostic odds ratio
Effective sample size
The EBM-CONNECT (Evidence-Based Medicine Collaboration: Network for systematic reviews and guideline development research and dissemination) Collaboration:
L. Mignini, Centro Rosarino de Estudios Perinatales, Argentina; P. von Dadelszen, L. Magee and D. Sawchuck, University of British Columbia, Canada; E. Gao, Shanghai Institute of Planned Parenthood Research, China; B.W. Mol and K. Oude Rengerink, Academic Medical Centre, The Netherlands; J. Zamora, Ramon y Cajal Hospital, Spain; C. Fox and J. Daniels, University of Birmingham, UK; K.S. Khan, S. Thangaratinam and C. Meads, Barts and the London School of Medicine, Queen Mary University of London, UK.
The authors received funding from the European Union made available to the EBM-CONNECT Collaboration through its Seventh Framework Programme, Marie Curie Actions, International Staff Exchange Scheme (proposal no.: 101377; grant agreement no.: 247613); EBM-CONNECT Canadian Collaborators received funding from the Canadian Institutes of Health Research.
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