Performance of 4 Clinical Decision Rules in the Diagnostic Management of Acute Pulmonary Embolism
| Autor: | Renée A, Douma, Inge C M, Mos, Petra M G, Erkens, Tessa A C, Nizet, Marc F, Durian, Marcel M, Hovens, Anja A, van Houten, Herman M A, Hofstee, Frederikus A, Klok, Hugo, ten Cate, Erik F, Ullmann, Harry R, Büller, Pieter W, Kamphuisen, Menno V, Huisman, A A, van Houten |
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| Přispěvatelé: | Interne Geneeskunde, Family Medicine, Biochemie, RS: CARIM School for Cardiovascular Diseases, Internal medicine, ICaR - Ischemia and repair, Hematology, Vascular Medicine, ACS - Amsterdam Cardiovascular Sciences, Other Research, Radiology and Nuclear Medicine, APH - Amsterdam Public Health, Epidemiology and Data Science, Laboratory for General Clinical Chemistry, Vascular Ageing Programme (VAP) |
| Rok vydání: | 2011 |
| Předmět: |
Adult
medicine.medical_specialty Decision tree macromolecular substances Clinical prediction rule clinical decision making Decision Support Techniques computer assisted tomography Fibrin Fibrinogen Degradation Products male Internal Medicine medicine follow up Humans controlled study human Prospective Studies Geneva score Prospective cohort study Intensive care medicine Netherlands Probability business.industry Respiratory disease article Retrospective cohort study Venous Thromboembolism General Medicine cohort analysis medicine.disease major clinical study Surgery Pulmonary embolism aged female priority journal D dimer Pulmonary Embolism Tomography X-Ray Computed business lung embolism prospective study Follow-Up Studies Cohort study |
| Zdroj: | Annals of Internal Medicine, 154(11), 14-718. American College of Physicians Annals of Internal Medicine, 154(11). American College of Physicians Annals of internal medicine, 154(11), 709-718. American College of Physicians Douma, R A, Mos, I C M, Erkens, P M G, Nizet, T A C, Durian, M F, Hovens, M M, van Houten, A A, Hofstee, H M A, Klok, F A, Ten Cate, H, Ullmann, E F, Buller, H R, Kamphuisen, P W & Huisman, M V 2011, ' Performance of 4 Clinical Decision Rules in the Diagnostic Management of Acute Pulmonary Embolism A Prospective Cohort Study ', Annals of Internal Medicine, vol. 154, no. 11 . https://doi.org/10.7326/0003-4819-154-11-201106070-00002 Annals of Internal Medicine, 154(11), 709-718. AMER COLL PHYSICIANS |
| ISSN: | 0003-4819 |
| Popis: | Background: Several clinical decision rules (CDRs) are available to exclude acute pulmonary embolism (PE), but they have not been directly compared. Objective: To directly compare the performance of 4 CDRs (Wells rule, revised Geneva score, simplified Wells rule, and simplified revised Geneva score) in combination with D-dimer testing to exclude PE. Design: Prospective cohort study. Setting: 7 hospitals in the Netherlands. Patients: 807 consecutive patients with suspected acute PE. Intervention: The clinical probability of PE was assessed by using a computer program that calculated all CDRs and indicated the next diagnostic step. Results of the CDRs and D-dimer tests guided clinical care. Measurements: Results of the CDRs were compared with the prevalence of PE identified by computed tomography or venous thromboembolism at 3-month follow-up. Results: Prevalence of PE was 23%. The proportion of patients categorized as PE-unlikely ranged from 62% (simplified Wells rule) to 72% (Wells rule). Combined with a normal D-dimer result, the CDRs excluded PE in 22% to 24% of patients. The total failure rates of the CDR and D-dimer combinations were similar (1 failure, 0.5% to 0.6% [upper-limit 95% CI, 2.9% to 3.1%]). Even though 30% of patients had discordant CDR outcomes, PE was not detected in any patient with discordant CDRs and a normal D-dimer result. Limitation: Management was based on a combination of decision rules and D-dimer testing rather than only 1 CDR combined with D-dimer testing. Conclusion: All 4 CDRs show similar performance for exclusion of acute PE in combination with a normal D-dimer result. This prospective validation indicates that the simplified scores may be used in clinical practice. Primary Funding Source: Academic Medical Center, VU University Medical Center, Rijnstate Hospital, Leiden University Medical Center, Maastricht University Medical Center, Erasmus Medical Center, and Maasstad Hospital. © 2011 American College of Physicians. |
| Databáze: | OpenAIRE |
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