How accurate are maternal symptoms in predicting impending complications in women with preeclampsia? A systematic review and meta-analysis.

BACKGROUND: Maternal symptoms such as severe headache, nausea and vomiting, visual disturbances and epigastric pain have been associated with complications in women with preeclampsia. OBJECTIVE: To determine the accuracy of maternal symptoms in predicting complications in women with preeclampsia by systematic review. DATA SOURCES: We searched MEDLINE (1951-2010), EMBASE (1980-2010), the Cochrane Library (2009) and the MEDION database. METHODS OF STUDY SELECTION: Studies which evaluated the accuracy of symptoms in women with preeclampsia for predicting complications were selected in a two-stage process. Information was extracted by two independent reviewers. We summarized accuracy with a bivariate model estimating sensitivity, specificity and area under the curve. RESULTS: Six primary articles with 2573 women were included. The area under the curve for predicting complications for headache, epigastric pain and visual disturbances was 0.58 (95%CI 0.24-0.86), 0.70 (95%CI 0.30-0.93) and 0.74 (95%CI 0.33-0.94). The sensitivity and specificity of the symptoms in predicting adverse maternal outcomes were respectively as follows: headache 0.54 (95%CI 0.27-0.79) and 0.59 (95%CI 0.38-0.76); epigastric pain 0.34 (95%CI 0.22-0.5) and 0.83 (95%CI 0.76-0.89); visual disturbances 0.27 (95%CI 0.07-0.65) and 0.81 (95%CI 0.71, 0.88); nausea and vomiting 0.24 (95%CI 0.21, 0.27) and 0.87 (95%CI 0.85, 0.89). CONCLUSION: The presence of symptoms is more useful in predicting complications in preeclampsia compared to their absence in excluding adverse events.