Combination of the clinical decision rules and D Dimer for the exclusion of proximal DVT in a hospital emergency department

2013 ◽  
Vol 24 ◽  
pp. e44
Author(s):  
F. Rosa-Jiménez ◽  
A. Carreras-Álvarez ◽  
A. Lozano-Rodríguez ◽  
A. Rosa-Jiménez ◽  
M.C. Duro-López ◽  
...  
2019 ◽  
Vol 49 (6) ◽  
pp. 739-744
Author(s):  
Christopher J. McLenachan ◽  
Olivia Chua ◽  
Betty S. H. Chan ◽  
Elia Vecellio ◽  
Angela L. Chiew

2014 ◽  
Vol 69 (4) ◽  
pp. 240-245 ◽  
Author(s):  
H. Kara ◽  
A. Bayir ◽  
S. Degirmenci ◽  
S. A. Kayis ◽  
M. Akinci ◽  
...  

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3186-3186
Author(s):  
Inge CM Mos ◽  
Renée A Douma ◽  
Petra MG Erkens ◽  
Tessa AC Nizet ◽  
Marc F Durian ◽  
...  

Abstract Abstract 3186 Background Several clinical decision rules (CDRs) are available for the exclusion of acute pulmonary embolism (PE). This prospective multi-center study compared the safety and clinical utility of four CDRs (Wells rule, revised Geneva score, simplified Wells rule and simplified revised Geneva score) in excluding PE in combination with D-dimer testing. Methods Clinical probability of patients with suspected acute PE was assessed using a computerized based “black box”, which calculated all CDRs and indicated the next diagnostic step. A “PE unlikely” result according to all CDRs in combination with a normal D-dimer result excluded PE, while patients with “PE likely” according to at least one of the CDRs or an abnormal D-dimer result underwent CT-scanning. Patients in whom PE was excluded were followed for three months. Results 807 consecutive patients were included and PE prevalence was 23%. The number of patients categorized as “PE unlikely” ranged from 62% (simplified Wells rule) to 72% (Wells rule). Combined with a normal D-dimer level, the CDRs excluded PE in 22–24% of patients. The total failure rates of the CDR-D-dimer combinations were similar (1 failure, 0.5– 0.6%, upper 95% CI 2.9– 3.1%). Despite 30% of the patients had discordant CDR outcomes, PE was missed in none of the patients with discordant CDRs and a normal D-dimer result. Conclusions All four CDRs show similar safety and clinical utility for exclusion of acute PE in combination with a normal D-dimer level. With this prospective validation, the more straightforward simplified scores are ready for use in clinical practice. Disclosures: No relevant conflicts of interest to declare.


2011 ◽  
Vol 4 (4) ◽  
pp. 99-104
Author(s):  
John H Park ◽  
Cole R Spresser ◽  
Jorge A Valdivia ◽  
Michael J Khadavi ◽  
Saikat Das ◽  
...  

Background. Pulmonary embolism (PE) is clinically suspected in many patients who complain of shortness of breath or chest pain due to its nonspecific nature. The prevalence of PE, however, is low in this population. To assist physicians in diagnostic decision making, several clinical decision rules (CDR) have been developed. The appropriate use of these CDRs has been proven to decrease the need for expensive, time consuming, and invasive diagnostic imaging procedures. In this study, the appropriateness of D-dimer and CT usage was investigated to rule out pulmonary emboli based on the simplified Geneva score. Methods. A retrospective review was performed on 74 patients with a CT scan ordered through a pulmonary embolism (PE) protocol. Using clinical data, the patients were stratified into “unlikely” and “likely” groups for the presence of PE based on the simplification of the revised Geneva score. Scores of 0-2 were graded as “unlikely” and scores of 3 or greater were “likely.” Results. There were 45/74 (60.8%) patients in the “unlikely” group. Of these, 14/45 (31.1%) received a D-dimer; eight were normal and six elevated. Only one patient in the elevated group had evidence of a PE. Of the remaining 31(39.2%) patients in the “unlikely” group that did not receive a D-dimer, only one had a PE. The “likely” group consisted of 29 (39.2%) patients of whom six received a D-dimer. Three patients had a normal D-dimer and three had an elevated level. Neither of these two groups had a PE. Of the remaining 23 (60.8%) in the “likely” group who did not receive a D-dimer, six had a PE. Conclusions. Diagnosing pulmonary emboli using D-dimer levels and CT scans may be aided by clinical decision rules such as the simplified Geneva system. This process may lead to more effective use of medical resources.


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