scholarly journals THE RELIABILITY OF CLINICAL PROBABILITY SCORE IN (WELLS SCORE) THE DIAGNOSIS OF PULMONARY EMBOLISM (PE) IN COVID-19 PATIENTS

2021 ◽  
Vol 9 (09) ◽  
pp. 345-349
Author(s):  
Saleh Alkhubaizi ◽  
◽  
Ahmad Al. ALalwi ◽  
Mamdoh Mahboob ◽  
Mohammed Al. Thubity ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Medical Records ◽  
Healthcare Professionals ◽  
Medical Center ◽  
Pulmonary Angiography ◽  
Clinical Probability ◽  
Study Results ◽  
Significant Difference ◽  
Wells Score ◽  
D Dimer

Background: The risk of developing pulmonary embolism (PE) is high in patients infected with COVID-19, and its diagnosis is a severe challenge for healthcare professionals duringthe COVID-19 pandemic. Physicians are frequently usingcomputed tomography pulmonary angiography(CTPA), d-dimer, and well score for the diagnosis of PE. Methods: A retrospective study was used in which we investigated the reliability of clinical well scores by collecting data, such as medical records in registered form (serum D-dimer level and Wells scores) of every patient for whom physicians have requested whose CTPA with suspicion of PE at King Faisal Medical Center (KFMC) from the period from 1st of April to the 1st of October. Results: The study results showed significantly higher values of d-dimer in patients with positive PEcompared to those with negative values. In addition wells score is not a reliable preclinical score in diagnosis PE in COVID 19 patient. Conclusions: As per the results of the well score, there is no significant difference between vulnerable people with PE +ve and -ve.

scholarly journals Relationship Between CRP, D-Dimer, D-Dimer/CRP with Clinical Probability and Diagnostic Value in Patients with Suspected Pulmonary Thoromboembolism

2021 ◽  
Author(s):  
Yunus Günkan ◽  
Cenk Babayiğit ◽  
Nursel Dikmen
Keyword(s):  
Pulmonary Embolism ◽  
Sensitivity And Specificity ◽  
Diagnostic Value ◽  
Pulmonary Angiography ◽  
Lung Scintigraphy ◽  
Reactive Protein ◽  
Clinical Probability ◽  
Wells Score ◽  
Diagnostic Values ◽  
D Dimer

Objective: It was planned to investigate the diagnostic values for pulmonary thromboembolisym (PTE) by examining D-dimer, C-Reactive Protein (CRP), D-dimer/CRP ratio of patients who underwent computed tomography pulmonary angiography (CTPA) and/or lung scintigraphy with pre-diagnosis of pulmonary embolism. So it was thought that unnecessary computed tomograpy pulmonary Angiography could be reduced. Method: In our study, patients who were admitted to the chest diseases outpatient clinic and emergency department, who underwent CT pumonary Angiography and/or lung scintigraphy with a pre-diagnosis of pulmonary embolism, and who were simultaneously studied for D-dimer and CRP examinations were retrospectively evaluated. The efficiency and reliability of the Wells score and the combination of D-dimer, CRP and D-dimer/CRP ratio in the prediagnosis of pulmonary embolism were evaluated. Results: 46 of 79 patients with suspected pulmonary embolism included in our study were diagnosed with pulmonary thromboembolism with advanced tests. While the sensitivity and specificity of Wells score, D-dimer and CRP in diagnosing PTE were 41.3-100%, 91.3-27.3% and 84.7-42.4%, respectively, the cut off value of D-dimer/CRP ratio was 119.5. We found statistically significant higher D-dimer levels in patients with probable PTE according to Wells clinical scores. However, D-dimer/CRP ratio and CRP levels were statistically insignificant. Conclusion: In our study, D-dimer and CRP ratios were found to be significantly higher in patients with PTE, but D-dimer/CRP ratios were found to be less valuable in the diagnosis of PTE sensitivity and specificity.

scholarly journals Wells and Geneva decision rules to predict pulmonary embolism: can we use them in Covid-19 patients?

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
BV Silva ◽  
C Jorge ◽  
J Rigueira ◽  
T Rodrigues ◽  
P Silverio Antonio ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Signs And Symptoms ◽  
Discriminatory Power ◽  
Average Score ◽  
Clinical Probability ◽  
Significant Difference ◽  
Wells Score ◽  
D Dimer

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Pulmonary embolism (PE) is a recognized complication of SARS-COV2 infection due to hypercoagulability. Before the COVID era, the need for computed tomography pulmonary angiography (CTPA) to rule out PE was determined by clinical probability, based on Wells and Geneva scores, in association with D-dimer measurements. However, patients with SARS-COV2 infection have a pro-thrombotic and pro-inflammatory state which may compromise the usefulness of these algorithms to select patients for CTPA.  Purpose  To evaluate the accuracy of the Wells and Geneva scores to predict PE in patients with SARS-COV2 infection. Methods  Retrospective study of consecutive outpatients with SARS-COV2 infection proved by positive PCR who underwent CTPA due to suspected PE. The Wells and Geneva scores were calculated and the area under the curve (AUC) of the receiver operating characteristic curve was measured. Results  We enrolled 235 patients (61% males, mean age 69.10 ± 16.69 years) and the incidence of pulmonary embolism was 15% (35 patients). In patients with PE, emboli were located mainly in segmental arteries (60%) and bilaterally (46%). Patients with PE were older (mean age 75.06 ± 2.23 vs. 68.06 ± 1.21 years, p = 0.022), and did not differ in sex or risk factors for thromboembolic diseases from the non-PE group. Patients with PE had higher D-dimer levels (median 15.41 mg/dl, IQR 1.17 – 20.00) compared to patients without PE (median 5.99 mg/dl, IQR 0.47 – 2.82, p < 0.001).  There was no statically significant difference between the average Wells score in patients with PE and without PE (1.04 and 0.89 respectively, p = 0.733) and the AUC demonstrated that the Wells score had no discriminatory power (AUC = 0.52). Within patients with PE, 19 patients had a Wells score of zero. Regarding the Geneva score, there was also no difference between the average score in patients with and without PE (4.20 vs 3.93 respectively, p = 0.420). AUC for Geneva score was 0.54. Clinical probability combined with D-dimer measurement had a 100% sensitivity for both Wells and Geneva scores, but a specificity of 10% and 11%, respectively.  Conclusion  PE diagnosis may be challenging in patients with SARS-COV2 infection since both conditions may have similar signs and symptoms and may be associated with increased D-dimers. According to our results, traditional clinical prediction scores have little discriminatory power in these patients and a higher D-dimer cut-off should be considered to better select patients for CTPA to minimize radiation exposure and contrast-related complications in COVID-19 patients.

scholarly journals Wells’ Score in Diagnosis of Pulmonary Embolism in Patient with Thrombocytopenia: A Case Report

2019 ◽  
Vol 20 (3) ◽  
pp. 281-285
Author(s):  
Dragan Panic ◽  
Andreja Todorovic ◽  
Milica Stanojevic ◽  
Violeta Iric Cupic
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Acute Pulmonary Embolism ◽  
Pretest Probability ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Clinical Probability ◽  
Wells Score ◽  
D Dimer

Abstract Current diagnostic workup of patients with suspected acute pulmonary embolism (PE) usually starts with the assessment of clinical pretest probability, using clinical prediction rules and plasma D-dimer measurement. Although an accurate diagnosis of acute pulmonary embolism (PE) in patients is thus of crucial importance, the diagnostic management of suspected PE is still challenging. A 60-year-old man with chest pain and expectoration of blood was admitted to the Department of Cardiology, General Hospital in Cuprija, Serbia. After physical examination and laboratory analyses, the diagnosis of Right side pleuropne monia and acute pulmonary embolism was established. Clinically, patient was hemodynamically stable, auscultative slightly weaker respiratory sound right basal, without pretibial edema. Laboratory: C-reactive protein (CRP) 132.9 mg/L, Leukocytes (Le) 18.9x109/L, Erythrocytes (Er) 3.23x1012/L, Haemoglobin (Hgb) 113 g/L, Platelets (Plt) 79x109/L, D-dimer 35.2. On the third day after admission, D-dimer was increased and platelet count was decreased (Plt up to 62x109/L). According to Wells’ rules, score was 2.5 (without symptoms on admission), a normal clinical finding with clinical manifestation of hemoptysis and chest pain, which represents the intermediate level of clinical probability of PE. After the recidive of PE, Wells’ score was 6.5. In summary, this study suggests that Wells’ score, based on a patient’s risk for pulmonary embolism, is a valuable guidance for decision-making in combination with knowledge and experience of clinicians. Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being consiered.

scholarly journals Investigation of Suspected Pulmonary Embolism at Hutt Valley Hospital with CT Pulmonary Angiography: Current Practice and Opportunities for Improvement

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Nick Kennedy ◽  
Sisira Jayathissa ◽  
Paul Healy
Keyword(s):  
Pulmonary Embolism ◽  
Current Practice ◽  
Pulmonary Angiography ◽  
Pretest Probability ◽  
British Thoracic Society ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Wells Score ◽  
Positive Rate ◽  
D Dimer

Aims. To study the use of CT pulmonary angiography (CTPA) at Hutt Hospital and investigate the use of pretest probability scoring in the assessment of patients with suspected pulmonary embolism (PE).Methods. We studied patients with suspected PE that underwent CTPA between January and May 2012 and collected data on demographics, use of pretest probability scoring, and use of D Dimer and compared our practice with the British Thoracic Society (BTS) guideline.Results. 105 patients underwent CTPA and 15% of patients had PE. 13% of patients had a Wells score prior to their scan. Wells score calculated by researchers revealed 54%, 36%, and 8% patients had low, medium, and high risk pretest probabilities and 8%, 20%, and 50% of these patients had positive scans. D Dimer was performed in 58% of patients and no patients with a negative D Dimer had a PE.Conclusion. The CTPA positive rate was similar to other contemporary studies but lower than previous New Zealand studies and some international guidelines. Risk stratification of suspected PE using Wells score and D Dimer was underutilised. A number of scans could have been safely avoided by using accepted guidelines reducing resources use and improving patient safety.

Overutilisation of imaging studies for diagnosis of pulmonary embolism: are we following the guidelines?

2019 ◽  
Vol 95 (1126) ◽  
pp. 420-424 ◽  
Author(s):  
Prajwal Dhakal ◽  
Mian Harris Iftikhar ◽  
Ling Wang ◽  
Varunsiri Atti ◽  
Sagar Panthi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Imaging Study ◽  
Pulmonary Angiography ◽  
Imaging Studies ◽  
Hospital Emergency ◽  
Wells Score ◽  
Observational Cohort ◽  
Current Guidelines ◽  
Retrospective Observational Cohort Study ◽  
D Dimer

ObjectiveTo evaluate if imaging studies such as CT pulmonary angiography (CTPA) or ventilation–perfusion (V/Q) scan are ordered according to the current guidelines for the diagnosis of pulmonary embolism (PE).MethodsWe performed a retrospective observational cohort study in all adult patients who presented to the Sparrow Hospital Emergency Department from January 2014 to December 2016 and underwent CTPA or V/Q scan. We calculated the Wells’ score retrospectively, and d-dimer values were used to determine if the imaging study was justified.ResultsA total of 8449 patients underwent CTPA (93%) or V/Q scan (7%), among which 142 (1.7%) patients were diagnosed with PE. The Wells’ criteria showed low probabilities for PE in 96 % and intermediate or high probabilities in 4 % of total patients. Modified Wells’ criteria demonstrated PE unlikely in 99.6 % and PE likely in 0.4 % of total patients. D-dimer was obtained in only 37 % of patients who were unlikely to have a PE or had a low score on Wells’ criteria. Despite a low or unlikely Wells’ criteria score and normal d-dimer levels, 260 patients underwent imaging studies, and none were diagnosed with PE.ConclusionMore than 99 % of CTPA or V/Q scans were negative in our study. This suggests extraordinary overutilisation of the imaging methods. D-dimer, recommended in patients with low to moderate risk, was ordered in only one-third of patients. Much greater emphasis of current guidelines is needed to avoid inappropriate utilisation of resources without missing diagnosis of PE.

scholarly journals P113: Comparison of age-adjusted and clinical probability-adjusted D-dimer for diagnosing pulmonary embolism

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S116
Author(s):  
S. Sharif ◽  
C. Kearon ◽  
M. Li ◽  
M. Eventov ◽  
R. Jiang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
False Negative ◽  
False Negative Rate ◽  
Retrospective Chart Review ◽  
Ct Scanning ◽  
Clinical Probability ◽  
Negative Rate ◽  
Wells Score ◽  
Acute Pe ◽  
D Dimer

Introduction: Diagnosing pulmonary embolism (PE) in the emergency department can be challenging due to non-specific signs and symptoms; this often results in the over-utilization of CT pulmonary angiography (CT-PA). In 2013, the American College of Chest Physicians identified CT-PA as one of the top five avoidable tests. Age-adjusted D-dimer has been shown to decrease CT utilization rates. Recently, clinical-probability adjusted D-dimer has been promoted as an alternative strategy to reduce CT scanning. The aim of this study is to compare the safety and efficacy of the age-adjusted D-dimer rule and the clinical probability-adjusted D-dimer rule in Canadian ED patients tested for PE. Methods: This was a retrospective chart review of ED patients investigated for PE at two hospitals from April 2013 to March 2015 (24 months). Inclusion criteria were the ED physician ordered CT-PA, Ventilation-Perfusion (VQ) scan or D-dimer for investigation of PE. Patients under the age of 18 were excluded. PE was defined as CT/VQ diagnosis of acute PE or acute PE/DVT in 30-day follow-up. Trained researchers extracted anonymized data. The age-adjusted D-dimer and the clinical probability-adjusted D-dimer rules were applied retrospectively. The rate of CT/VQ imaging and the false negative rates were calculated. Results: In total, 1,189 patients were tested for PE. 1,129 patients had a D-dimer test and a Wells score less than 4.0. 364/1,129 (32.3%, 95%CI 29.6-35.0%) would have undergone imaging for PE if the age-adjusted D-dimer rule was used. 1,120 patients had a D-dimer test and a Wells score less than 6.0. 217/1,120 patients (19.4%, 95%CI 17.2-21.2%) would have undergone imaging for PE if the clinical probability-adjusted D-dimer rule was used. The false-negative rate for the age-adjusted D-dimer rule was 0.3% (95%CI 0.1-0.9%). The false-negative rate of the clinical probability-adjusted D-dimer was 1.0% (95%CI 0.5-1.9%). Conclusion: The false-negative rates for both the age-adjusted D-dimer and clinical probability-adjusted D-dimer are low. The clinical probability-adjusted D-dimer results in a 13% absolute reduction in CT scanning compared to age-adjusted D-dimer.

scholarly journals Deciding on thrombolytic therapy in pulmonary embolism - is there room for lactate?

2018 ◽  
Vol 146 (7-8) ◽  
pp. 436-439
Author(s):  
Dusanka Obradovic ◽  
Biljana Joves ◽  
Svetislava Milic ◽  
Jovan Matijasevic ◽  
Stanislava Sovilj-Gmizic
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Thrombolytic Therapy ◽  
Hemodynamic Instability ◽  
Positive Outcome ◽  
Pulmonary Angiography ◽  
Clinical Probability ◽  
Tissue Hypoperfusion ◽  
Therapeutic Algorithms ◽  
Wells Score

Introduction. Diagnostic and therapeutic algorithms for pulmonary embolism (PE) have been frequently modified; however, determining clinical probability, which dictates further procedures, has remained the first step. The objective was to illustrate therapeutic dilemma in a patient with intermediate high risk for 30-day mortality. Case outline. The patient was a 56-years-old woman who was referred to our institution for suspected PE. According to the Wells score, the patient was deemed as low-probability for venous thromboembolism, and after further stratification she was placed in a group with intermediate high risk for 30-day mortality. PE was confirmed by computerised tomography pulmonary angiography and she initially received heparin. During the further clinical course, she developed hemodynamic instability, and she received thrombolytic therapy, with a positive outcome. The patient also had increased lactate at admission ? marker of tissue hypoperfusion which is not a part of the routine laboratory work-up in PE patients. Conclusion. Current guidelines state that patients with intermediate high risk for 30-day mortality should be treated with heparin, and then continuously monitored in order to timely recognize potential hemodynamic instability and consequently apply thrombolytics. In the outlined case, thrombolytic therapy was applied only after the patient developed hemodynamic instability, although previously she had early signs of tissue hypoperfusion.

scholarly journals Acute Pulmonary Embolism in Coronavirus Disease 2019

2020 ◽  
Author(s):  
Yanan Guo ◽  
Wenwu Sun ◽  
Yanli Liu ◽  
Yanling Lv ◽  
Su Zhao ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Pulmonary Angiography ◽  
Severe Condition ◽  
Computed Tomographic ◽  
Number Of Patients ◽  
Wells Score ◽  
Computed Tomographic Pulmonary Angiography ◽  
D Dimer

Abstract Background Pulmonary embolism is a severe condition prone to misdiagnosis given its nonspecific signs and symptoms. Previous studies on the pneumonia outbreak caused by coronavirus disease 2019 (COVID-19) showed a number of patients with elevated d-dimer, whether those patients combined with pulmonary embolism got our attention. Methods Data on clinical manifestations, laboratory and radiological findings, treatment, and disease progression of 19 patients with laboratory-confirmed COVID-19 pneumonia,who completed computed tomographic pulmonary angiography (CTPA) during hospitalization in the Central Hospital of Wuhan from January 2 to March 26, 2020, were reviewed. Results Of the 19 suspected pulmonary embolism and subjected to CTPA patients, six were diagnosed with pulmonary embolism. The Wells’ score of the six patients with pulmonary embolism was 0–1, which suggested a low risk of pulmonary embolism. The median level of d-dimers collected at the day before or on the day of CTPA completion in the patients with pulmonary embolism was 18.36 (interquartile range [IQR]: 6.69–61.46) µg/mL, which was much higher than that in the patients without pulmonary embolism (median 9.47 [IQR: 4.22–28.02] µg/mL). Of the 6 patients diagnosed with pulmonary embolism, all patients received anticoagulant therapy, 5 of which survived and were discharged and 1 died. Conclusion A potential causal relationship exists between COVID-19 infection and pulmonary embolism, but whether this phenomenon is common remains uncertain. The clinical manifestations of COVID-19 patients who developed pulmonary embolism are similar to those of patients with increased d-dimer alone, prompting a significant challenge on differential diagnoses.

Exclusion of pulmonary embolism using C-reactive protein and D-dimer

2003 ◽  
Vol 90 (12) ◽  
pp. 1198-1203 ◽  
Author(s):  
Daniel Hayoz ◽  
Bertrand Yersin ◽  
Arnaud Perrier ◽  
Ghassan Barghouth ◽  
Pierre Schnyder ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Judgment ◽  
Prediction Rule ◽  
Pulmonary Angiography ◽  
Enzyme Linked Immunosorbent Assay ◽  
Probability Assessment ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Clinical Probability ◽  
D Dimer

SummaryOur goal was to evaluate the diagnostic utility of C-reactive protein (CRP) alone or combined with clinical probability assessment in patients with suspected pulmonary embolism (PE), and to compare its performance to a D-dimer assay. We conducted a prospective study in which we performed a common immuno-turbidimetric CRP test and a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer test in 259 consecutive outpatients with suspected PE at the emergency department of a teaching hospital. We assessed clinical probability of PE by a validated prediction rule overridden by clinical judgment. Patients with D-dimer levels ≥ 500 µg/l underwent a work-up consisting of lower-limb venous ultrasound, spiral computer-ized tomography, ventilation-perfusion scan, or pulmonary angiography. Patients were followed up for three months. Seventy-seven (30%) of the patients had PE.The CRP alone had a sensitivity of 84% (95% confidence interval [CI).: 74 to 92%) and a negative predictive value (NPV) of 87% (95% CI: 78 to 93%) at a cutpoint of 5 mg/l. Overall, 61 (24%) patients with a low clinical probability of PE had a CRP < 5 mg/l. Due to the low prevalence of PE (9%) in this subgroup, the NPV increased to 97% (95% CI: 89 to 100%). The D-dimer (cutpoint 500 µg/l) showed a sensitivity of 100% (95% CI: 95 to 100%) and a NPV of 100% (95% CI: 94 to 100%) irrespective of clinical probability and accurately rule out PE in 56 (22%) patients. Standard CRP tests alone or combined with clinical probability assessment cannot safely exclude PE.

scholarly journals Physician and Patient Beliefs and Preferences in Pulmonary Embolism and Deep Vein Thrombosis Testing in People with Cancer

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4265-4265
Author(s):  
Anna Tran ◽  
Kerstin De Wit ◽  
Darshana Seeburruth
Keyword(s):  
Pulmonary Embolism ◽  
Diagnostic Imaging ◽  
Cancer Patients ◽  
Evidence Based ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Wells Score ◽  
Low Threshold ◽  
Deep Vein ◽  
D Dimer

Abstract Introduction It is unclear whether evidence-based diagnostic protocols are followed when cancer patients are tested for venous thromboembolism (VTE). Evidence-based protocols reduce unnecessary diagnostic imaging, offer a patient-centered approach, and have the potential to standardize practice across medical specialties and settings. However, anecdote suggests that specialists who test people with cancer for VTE may prefer diagnostic imaging over clinical probability scoring and D-dimer testing. The aim of this study was to identify physician and patient knowledge, beliefs, values and preferences for VTE testing in cancer. This study was part of a program of research to set International Society of Thrombosis and Haemostasis standards for VTE testing in people with cancer. Methods This was an international qualitative interview study following COREQ guidelines. Semi-structured interviews with physicians and cancer patients were conducted via Zoom. We used purposive sampling to ensure inclusion of physicians from all specialties who test people with cancer for VTE, practicing across all continents. We invited people treated for cancer who had and did not have experience of VTE testing. We used grounded theory to create a conceptual framework which explains physician and patient values and preferences for VTE testing. Transcripts were coded by three researchers independently, who met to discuss their findings and agree on common codes. Researchers were a Thrombosis physician and two undergraduate students who ensured reflexivity was incorporated into their analysis. Results A total of 32 physicians and 6 cancer patients were invited to interview. Of those invited, 23 physicians and 6 patients across 6 continents completed an interview. Interviews lasted between 21 and 86 minutes. Our derived conceptual model can be seen in the attached Figure. Physicians reported a low threshold to test for VTE in people with cancer compared to those without cancer, because VTE was considered a fatal disease and highly prevalent in this patient population. Imaging was generally the only test used for VTE testing in cancer patients. Many participants relied on their Gestalt estimation of VTE probability when deciding whether to order imaging for pulmonary embolism or deep vein thrombosis. Most thought that low Wells score in combination with a negative D-dimer was not sufficiently sensitive to exclude VTE and anticipated the Wells score and D-dimer to be elevated. The Wells scores had poor face validity because they do not include cancer-specific variables and participants hoped to see a more nuanced formal score for VTE testing in cancer patients. Participants believed that their colleagues would support their diagnostic approach. Patients reported they were used to having tests and CT scans. Patients felt it was important for their physicians to prioritize testing for VTE. Patients had full trust and confidence in their physicians' testing decisions, particularly in decisions made by their oncologists. Conclusion Physicians have a low threshold to test people with cancer for VTE and tend not to use clinical probability assessment and D-dimer. Patients are comfortable having diagnostic imaging, feel VTE testing is important and have full trust in their physicians. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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