Key result
McConnell's sign rules in pulmonary embolism with ~98% specificity but lacks sensitivity to rule out.
Why the study?
How accurate is McConnell's sign on transthoracic echocardiography for diagnosing pulmonary embolism in adult patients?
Meta-Analysis (n=1,555)
How accurate is McConnell's sign on transthoracic echocardiography for diagnosing pulmonary embolism in adult patients?
Effect estimate: Sensitivity 30%, Specificity 98% (95% CI Sensitivity 27-34%, Specificity 97-99%)
McConnell's sign has high specificity (98%) but low sensitivity (30%) for diagnosing pulmonary embolism, making it a useful rule-in test but inadequate for ruling out the condition.
Background/Introduction Pulmonary embolism (PE) is a life-threatening condition that requires prompt and accurate diagnosis. McConnell’s sign is a specific regional pattern of right ventricular dysfunction on tranthoracic echocardiography, with akinesis of the mid free wall and normo- or hyperkinesis of the apical wall. Purpose To determine how accurate McConnell’s sign is for diagnosing PE. Methods We used the Cochrane methods for diagnostic test accuracy (DTA) reviews. We searched Pubmed, Ovid, CENTRAL, OATD, ClinicalTrials.gov and WHO-ICTRP up to 01 March 2025. We included studies that assess the accuracy of McConnell’s sign against CT Pulmonary Angiography or Lung Ventilation Perfusion Scan in adult patients. The articles were screened and data from the articles was extracted using the Metagear package in R Studio. We extracted data into a 2 x 2 table (true positives, true negatives, false positives, and false negatives). We used a bivariate meta-analysis model to synthesize the meta-analysis in RevMan and synthesized and summarized the data into a forest plot. Results We identified 9286 titles and abstracts, and after removal of duplicates, we assessed 8023 unique studies. After exclusion, 12 studies were deemed eligible for inclusion in the meta-analysis (1555 patients). McConnell’s sign showed a summary sensitivity of 30% (95% CI 27% to 34%) and a summary specificity of 98% (95% CI 97% to 99%). If we take the median prevalence of PE in the included studies (33%) and apply it to a cohort of 1000 patients, 330 patients will have PE. Of these, 99 (30%) would be correctly diagnosed and 231 (70%) would be misdiagnosed and not receive appropriate treatment. 670 of the 1000 patients will have no PE. Of these, 657 (98%) would be correctly deemed to have no PE, and 13 (2%) would be falsely diagnosed with PE and undergo inappropriate treatment. Conclusion(s) The findings of this review suggest that McConnell’s sign, due to its high specificity, can serve as a valuable rule-in test for suspected PE when present. However, its low sensitivity indicates that a negative result cannot reliably exclude PE. Therefore, McConnell's sign should be used as a supportive finding in conjunction with clinical assessment and other diagnostic modalities.Summary of findings Forest Plot
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Kirkovski et al. (2026) conducted a meta-analysis in Pulmonary embolism (n=1,555). McConnell's sign vs. CT Pulmonary Angiography or Lung Ventilation Perfusion Scan was evaluated on Diagnostic accuracy of McConnell's sign for pulmonary embolism (Sensitivity 30%, Specificity 98%, 95% CI Sensitivity 27-34%, Specificity 97-99%). McConnell's sign demonstrated a high summary specificity of 98% (95% CI 97-99%) and a low summary sensitivity of 30% (95% CI 27-34%) for diagnosing pulmonary embolism.
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