A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism

Kruip, Marieke J.H.A.; Söhne, Maaike; Nijkeuter, Mathilde; Erp, H. M. Kwakkel‐Van; Tick, Lidwine W.; Halkes, S.; Prins, Martin H.; Kramer, Mark H. H.; Huisman, Menno V.; Büller, Harry R.; Leebeek, Frank W.G.

doi:10.1111/j.1365-2796.2006.01709.x

Cited by 41 publications

(19 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Conversely, data from the present study show that the clinical reference standard is safe to rule out PE in hospitalised patients, with a 3-month risk of VTE of 3.8% that compares favourably with the few studies that have reported on the outcome of in-patients in this setting [18][19][20]. When compared with the population of emergency patients with suspected PE included in previous studies, the present study population is older and more likely to have cancer [10,11,17].…”

Section: Discussionsupporting

confidence: 53%

Diagnosis of pulmonary embolism in hospitalised patients: retrospective survey of an institutional standard

Jouveshomme¹,

Böhn²,

Cazaban³

2007

Eur Respir J

View full text Add to dashboard Cite

The aim of the present study was to assess the safety and implementation of a diagnostic strategy in hospitalised patients with suspected acute pulmonary embolism (PE).A diagnostic strategy was established and implemented in a general hospital. A retrospective cohort study, including 400 consecutive in-patients, was performed in order to assess the appropriateness of the diagnostic management and the incidence of symptomatic venous thromboembolic events (VTE) during follow-up.PE was confirmed in 116 (29%) patients. The incremental value of adding compression ultrasonography (CUS) to multidetector-row computed tomography (MDCT) for the diagnosis of PE was 8.6%. PE was appropriately excluded in 169 (42%) patients due to a normal lung scan (n534), a negative MDCT providing an alternative diagnosis (n594), and a negative MDCT and CUS (n541). During follow-up, VTE occurred in 3.5% patients. The almost unique cause of inappropriate management was the absence of further work-up after a MDCT-negative result for PE providing no alternative diagnosis (n5115). Inappropriate management was associated with a nonsignificant increased risk of VTE (7.2%).A frontline diagnostic work-up based on pulmonary multidetector-row computed tomography associated with a compression ultrasonography of the leg veins is effective and more sensitive than pulmonary multidetector-row computed tomography alone in ruling out pulmonary embolism.

show abstract

Section: Discussionsupporting

confidence: 53%

Diagnosis of pulmonary embolism in hospitalised patients: retrospective survey of an institutional standard

Jouveshomme¹,

Böhn²,

Cazaban³

2007

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Within our patient cohort, d-dimer testing was not routinely performed before CT pulmonary angiographic imaging. However, studies have shown that the use of d-dimer testing, in combination with a clinical decision rule that was incorporated in our intervention, may be used effectively to exclude PE in the inpatient population (28)(29)(30).…”

Section: Health Policy and Practice: Evidence-based Clinical Decisionmentioning

confidence: 99%

Effect of Evidence-based Clinical Decision Support on the Use and Yield of CT Pulmonary Angiographic Imaging in Hospitalized Patients

Dunne¹,

Ip²,

Abbett³

et al. 2015

Radiology

View full text Add to dashboard Cite

MPH Purpose:To determine the effect of clinical decision support (CDS) on the use and yield of inpatient computed tomographic (CT) pulmonary angiography for acute pulmonary embolism (PE). Materials and Methods:This HIPAA-compliant, institutional review board-approved study with waiver of informed consent included all adults admitted to a 793-bed teaching hospital from April 1, 2007, to June 30, 2012. The CDS intervention, implemented after a baseline observation period, informed providers who placed an order for CT pulmonary angiographic imaging about the pretest probability of the study based on a validated decision rule. Use of CT pulmonary angiographic and admission data from administrative databases was obtained for this study. By using a validated natural language processing algorithm on radiology reports, each CT pulmonary angiographic examination was classified as positive or negative for acute PE. Primary outcome measure was monthly use of CT pulmonary angiography per 1000 admissions. Secondary outcome was CT pulmonary angiography yield (percentage of CT pulmonary angiographic examinations that were positive for acute PE). Linear trend analysis was used to assess for effect and trend differences in use and yield of CT pulmonary angiographic imaging before and after CDS. Results:In 272 374 admissions over the study period, 5287 patients underwent 5892 CT pulmonary angiographic examinations. A 12.3% decrease in monthly use of CT pulmonary angiography (26.0 to 22.8 CT pulmonary angiographic examinations per 1000 admissions before and after CDS, respectively; P = .008) observed 1 month after CDS implementation was sustained over the ensuing 32-month period. There was a nonsignificant 16.3% increase in monthly yield of CT pulmonary angiography or percentage of CT pulmonary angiographic examinations positive for acute PE after CDS (P = .65). Conclusion:Implementation of evidence-based CDS for inpatients was associated with a 12.3% immediate and sustained decrease in use of CT pulmonary angiographic examinations in the evaluation of inpatients for acute PE.q RSNA, 2015

show abstract

“…291 hastada klinik olasılık zayıf olarak tespit edilmiş ve bu hastaların 60'ında d-dimer normal sınırlarda saptanmıştır. Normal d-dimer, zayıf klinik olasılık ile birlikte değerlendirildiğinde hastaların %10'unda PE dışlanmış ve takiplerinde PE geliş-mediği gözlenmiş [30]. Bizim çalışmamızda ise PE (+) ve PE (-) hastalarda zayıf ve kuvvetli olasılıklar arasında d-dimer testinin ortalama değerleri açısın-dan istatistiksel olarak anlamlı farklılık görülmedi.…”

Section: J Clin Exp Invest Wwwjceionlineorg Vol 5 No 4 December 2014unclassified

Combination of Wells clinical score and high D-dimer levels in the diagnosis of pulmonary embolism

Yılmaz

Topçu²,

Şen³

et al. 2014

J Clin Exp Invest

View full text Add to dashboard Cite

ÖZETAmaç: Pulmoner emboli (PE) mortalite ve morbiditesi yüksek, tekrarlayabilen, bazen tanısı güç olan ve önlene-bilir bir hastalıktır. Bu çalışmanın amacı hızlı, noninvaziv, ucuz ve kolay elde edilebilir laboratuvar parametresi olan d-dimer ile Wells klinik tahmin skorlaması kombinasyonunun PE tanısına katkısı araştırmaktır.Yöntemler: Bu çalışmada PE pozitif 46 ve negatif 24 olan toplamda 70 hasta prospektif olarak değerlendirilmiştir. İlk olarak Wells klinik skorlaması hesaplandı ve d-dimer düzeyleri ölçüldü. Bütün hastalarda d-dimer testi normal değerlerin üzerindeydi. Pulmoner emboli hastaları masif, submasif ve non-masif olarak 3 guruba ayrıldı. Bütün hastalara bilgisayarlı tomografik pulmoner anjiyografi çekimi yapıldı.Bulgular: Düşük-orta, düşük-yüksek ve orta-yüksek olasılıklar arasında D-dimer'in ortalama değerleri açısından PE(+) hastalarda anlamlı farklılık görülmedi. PE(-) hastalarda ise orta-yüksek klinik olasılıklar karşılaştırıldığında d-dimer (p=0,036) ortalama değeri yüksek klinik olasılıkta anlamlı şekilde yüksek bulundu. Masif grupta non-masif gruba göre d-dimer düzeyi ortalama değerleri anlamlı derecede yüksek bulundu (p=0,02). Sonuç:Hastalarımızın tümünde d-dimer testi normal değerlerin üzerindeydi. Buna rağmen literatür ile karşılaştır-dığımızda sonuçlarımızda anlamlı farklılıklar tespit etmedik. Bu nedenle d-dimer testinin yeni cut-off değerlerinin belirlenmesi için daha geniş popülasyonlu çalışmaların yapılması gerektiğini vurgulamak istiyoruz. Anahtar kelimeler:Pulmoner emboli, D-dimer, klinik olasılık ABSTRACT Objective: Pulmonary embolism is a preventable disease that is sometime difficult to diagnosed, can be recurrent and has a high morbidity and mortality. The aim of our study is to investigate the contribution of d-dimer, which is noninvasive, fast, cheap and easy obtainable laboratory parameter and Wells clinical prediction scoring combination to the diagnosis of PE. Methods:In this study, PE positive 46 and negative 24 in the total 70 patients were evaluated prospectively. Initially clinical scoring system was calculated Wells and ddimer levels were measured. The levels of d-dimer were over the normal level in all patients. Patients with PE were divided into 3 groups as massive, submassive and nonmassive. All patients were performed shooting with computed tomographic pulmonary angiography.Results: Among Low-moderate, low-high and moderatehigh probabilities the mean value of d-dimer did not differ significantly in the PE (+) patients. In patients with PE (-) moderate and high clinical probability were compared and the d-dimer (p = 0.036) mean value was significantly higher in the high clinical probability. In massive group the mean values levels of d-dimer were significantly higher than the non-massive group (p=0.02). Conclusion:In all cases D-dimer levels were above normal values. Nevertheless, when we compare our results with the literature did not detect significant differences. Therefore, we want to emphasize that new larger studies needed for the determination of new cut-off ...

show abstract

A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism

Cited by 41 publications

References 32 publications

Diagnosis of pulmonary embolism in hospitalised patients: retrospective survey of an institutional standard

Diagnosis of pulmonary embolism in hospitalised patients: retrospective survey of an institutional standard

Effect of Evidence-based Clinical Decision Support on the Use and Yield of CT Pulmonary Angiographic Imaging in Hospitalized Patients

Combination of Wells clinical score and high D-dimer levels in the diagnosis of pulmonary embolism

Contact Info

Product

Resources

About