Accuracy of biochemical markers for predicting nasogastric tube placement in adults - A systematic review of diagnostic studies

Fernandez, Ritin S, Chau, Janita Pak-Chun, Thompson, David R, Griffiths, Rhonda and Lo, Hoi-Shan (2010) Accuracy of biochemical markers for predicting nasogastric tube placement in adults - A systematic review of diagnostic studies. International Journal of Nursing Studies, 47 8: 1037-1046. doi:10.1016/j.ijnurstu.2010.03.015

Author Fernandez, Ritin S
Chau, Janita Pak-Chun
Thompson, David R
Griffiths, Rhonda
Lo, Hoi-Shan
Title Accuracy of biochemical markers for predicting nasogastric tube placement in adults - A systematic review of diagnostic studies
Journal name International Journal of Nursing Studies   Check publisher's open access policy
ISSN 0020-7489
Publication date 2010-08
Year available 2010
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.ijnurstu.2010.03.015
Volume 47
Issue 8
Start page 1037
End page 1046
Total pages 10
Editor Mary Fitzgerald
Sue Holmes
Ian Norman
Place of publication Bromley, United Kingdom
Publisher Elsevier
Collection year 2011
Language eng
Subject 110307 Gastroenterology and Hepatology
920203 Diagnostic Methods
Formatted abstract
The objective of this study was to investigate the diagnostic performance of
biochemical tests used to determine placement of nasogastric (NG) tubes after insertion in adults.

A systematic review of diagnostic studies was undertaken.

Data sources
A literature search of the bibliographic databases and the World Wide Web was performed to locate original diagnostic studies in English or Chinese on biochemical markers for detecting NG tube location.

Review methods
Studies in which one or more different tests were evaluated with a
reference standard, and diagnostic values were reported or could be calculated were
included. Two reviewers independently checked all abstracts and full text studies for
inclusion criteria. Included studies were assessed for their quality using the QUADAS tool. Study features and diagnostic values were extracted from the included studies.


Of the 10 studies included in this review, seven investigated the diagnostic
accuracy of pH, one investigated the diagnostic accuracy of pH and bilirubin respectively, two a combination of pH and bilirubin and one a combination of pH, pepsin and trypsin levels in identifying NG tube location. All studies used X-rays as the reference standard for comparison. Pooled results demonstrated that a pH of </= 4.0 had the ability to predict only 63% of the tubes located in the stomach. However, a pH value of </= 5.5 to determine gastric placement demonstrated a sensitivity of 0.89 (95% CI 0.82–0.94) and a specificity of 0.87 (95% CI 0.81–0.93). Bilirubin coupled with pH had a high specificity (0.99) which demonstrated the ability of the test to identify misplaced tubes in intestine. However, the ability of the test to correctly identify gastric placement of feeding tubes was relatively low (sensitivity <0.90).

Due to the heterogeneity of the studies and small sample sizes, conclusions about the diagnostic performance of the different tests cannot be drawn. Better designed studies exploring the accuracy of diagnostic tests are needed to improve the diagnostic policy. Until stronger evidence becomes available practice related to the diagnostic tests used within the clinical setting will continue to be dictated by local preferences and cost factors.
Keyword nasogastric tubes
diagnostic accuracy
systematic review
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Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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Created: Thu, 29 Jul 2010, 15:22:28 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work