Data sources PubMed, Scopus and Web of Science.

Study selection Cohort (retrospective and prospective) and cross-sectional clinical studies investigating the diagnostic accuracy of the cold pulp test (CPT), heat pulp test (HPT), electric pulp test (EPT), laser Doppler flowmetry (LDF) and pulp oximeter (PO). Pulpal diagnosis was confirmed by histological analysis, direct clinical observations (access cavity) or evidence of root canal filling (to confirm nonvital teeth).

Data extraction and synthesis The diagnostic test's sensitivity (Sn), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted or calculated from the raw data of each included study. The test's outcomes were binary. A true positive (TP) was considered to have occurred when the diagnostic instrument correctly tested positive for a non-vital pulp and true negative (TN) when it correctly tested negative for a vital pulp based on a standard reference test. A false positive (FP) and false negative (FN) occurred when the test incorrectly tested positive on a vital pulp and incorrectly tested negative on a non-vital pulp, respectively. Accuracy, PPV and NPV were adjusted (Adj.Accuracy, Adj.PPV and Adj.NPV respectively) based on a standardised total disease (non-vital pulps) prevalence (Prev.) of 42.8%. Pool estimates for all five dental pulp vitality diagnostic variables (Sn, Sp, Adj.Accuracy, Adj.PPV and Adj.NPV) were generated with a meta-analysis using a random effects model. Included studies were assessed as either high, moderate or low quality based on the Quality Assessment of Diagnostic Accuracy Studies tool.

Results Twenty-eight studies met the inclusion criteria. The pooled Sn, Sp, Adj.Accuracy, Adj.PPV and Adj.NPV for each test are given in the Table 1. Heterogeneity between studies was significant for CPT, HPT and EPT; it was mild to moderate for LDF and PO. All but three studies were determined to be of low quality, with only one assessed as high quality.

Conclusions The most accurate dental pulp tests are the LDF and PO, with the HPT least accurate. CPT has generally high diagnostic accuracy and can be considered the primary pulp testing method in clinical practice.

数据来源PubMed，Scopus和Web of Science 。

研究选择队列（回顾性和前瞻性）和横断面临床研究，研究冷纸浆测试（CPT），热纸浆测试（HPT），电纸浆测试（EPT），激光多普勒血流仪（LDF）和纸浆血氧仪的诊断准确性（PO）。通过组织学分析，直接的临床观察（进入腔）或牙根管充盈的证据（以确认非生牙）来证实牙髓的诊断。

数据提取和综合从每个纳入研究的原始数据中提取或计算出诊断测试的灵敏度（Sn），特异性（Sp），准确性，阳性预测值（PPV）和阴性预测值（NPV）。测试的结果是二进制的。当诊断仪器根据标准参考测试正确地对非重要纸浆测试呈阳性时，认为已发生了真正的阳性（TP），而当诊断仪器对重要的纸浆进行了正确测试为阴性时，则出现了真正的阴性（TN）。当测试在重要纸浆上的测试结果不正确时，在非重要纸浆上的测试结果错误时，分别出现了假阳性（FP）和假阴性（FN）。调整了准确度，PPV和NPV（Adj.Accuracy，Adj.PPV和ANP.NPV分别基于42.8％的标准化总疾病（非重要牙髓）患病率（Prev。）。使用随机效应模型进行荟萃分析，生成所有五个牙髓活力诊断变量（Sn，Sp，Adj.Accuracy，Adj.PPV和Adj.NPV）的池估计值。根据诊断准确性研究工具的质量评估，将纳入的研究评估为高，中或低质量。

结果28项研究符合纳入标准。表1给出了每个测试的总Sn，Sp，Adj.Accuracy，Adj.PPV和ANP.NPV。研究之间的异质性对CPT，HPT和EPT十分重要。LDF和PO轻度至中度。除三项研究外，所有研究均被确定为低质量，只有一项评估为高质量。

结论最准确的牙髓测试是LDF和PO，而HPT的准确性最低。CPT通常具有很高的诊断准确性，可以被认为是临床实践中主要的纸浆测试方法。