scholarly journals D-dimer level has higher correlation with pulmonary embolism diagnosis than a clinical prediction score

2021 ◽  
Author(s):  
Joseph Lee ◽  
Ramin Alipour ◽  
Goran Mitric ◽  
Philip Masel ◽  
Jia Wen Chong
Keyword(s):  
Pulmonary Embolism ◽  
Medical Records ◽  
Risk Groups ◽  
Final Diagnosis ◽  
Prediction Score ◽  
Risk Category ◽  
Clinical Prediction ◽  
Pulmonary Embolism Diagnosis ◽  
The Absolute ◽  
D Dimer

Aim This study aimed to compare the predictive value of D-dimer and a clinical prediction score in diagnosis of pulmonary embolism (PE) as this could improve practice and reduce costs simultaneously. Method To achieve this, medical records of patients who presented to the Emergency Department of a large Australian metropolitan general hospital over 12 months and underwent DD testing were reviewed. The correlation coefficient (CC) was calculated using the Cramer’s V method. Results CC between low-, intermediate- and high-risk groups on their own and a final diagnosis of PE on imaging was 0.1332, 0.1278 and 0.0817, respectively. By contrast, the CC when using positive DD was higher for all categories: 0.7527, 0.6256 and 0.4195, respectively. For the age-adjusted DD, the correlations were higher than for the clinical prediction score but less than for the absolute DD; calculated at 0.6490, 0.4987 and 0.3550 for the respective groups. The overall CC for risk category was 0.1107; for a positive DD, it was 0.7033; for the age-adjusted DD, it was 0.5928. Conclusion Positive DD has a higher correlation with PE diagnosis than the clinical prediction score. DD assay, whether positive or negative, is therefore an invaluable test in assessment of patients with suspected PE and can help determine the need for tomographic imaging. The absolute DD is more useful than the age-adjusted value.

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 Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

2017 ◽  
Vol 32 (2) ◽  
pp. 148-153
Author(s):  
Asifa Karamat ◽  
Shazia Awan ◽  
Muhammad Ghazanfar Hussain ◽  
Fahad Al Hameed ◽  
Faheem Butt ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Clinical Prediction ◽  
Prediction Rules ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
D Dimer

scholarly journals P142: Diagnosis of pulmonary embolism in the Canadian context: clinical review findings from a health technology assessment

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S107-S107
Author(s):  
A. Sinclair ◽  
K. Peprah ◽  
T. Quay ◽  
S. Mulla ◽  
L. Weeks
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Diagnostic Imaging ◽  
Laboratory Testing ◽  
Meta Analysis ◽  
Health Technology ◽  
Clinical Prediction ◽  
Prediction Rules ◽  
Canadian Context ◽  
D Dimer

Introduction: Pulmonary embolism (PE) is a diagnostic challenge, since it shares symptoms with other conditions. Missed diagnosis puts patients at a risk of a potentially fatal outcome, while false positive results leave them at risk of side effects (bleeding) from unnecessary treatment. Diagnosis involves a multi-step pathway consisting of clinical prediction rules (CPRs), laboratory testing, and diagnostic imaging, but the best strategy in the Canadian context is unclear. Methods: We carried out a systematic review of the diagnostic accuracy, clinical utility, and safety of diagnostic pathways, CPRs, and diagnostic imaging for the diagnosis of PE. Clinical prediction rules were studied by an overview of systematic reviews, and pathways and diagnostic imaging by a primary systematic review. Where feasible, a diagnostic test meta-analysis was conducted, with statistical adjustment for the use of variable and imperfect reference standards across studies. Results: The Wells CPR rule showed greater specificity than the Geneva, but the relative sensitivities were undetermined. Application of a CPR followed by with D-dimer laboratory testing can safely rule out PE. In diagnostic test accuracy meta-analysis, computed tomography (CT) (sensitivity 0.973, 95% CrI 0.921 to 1.00) and ventilation/perfusion single-photon emission CT (VQ-SPECT) (sensitivity 0.974, 95% CrI 0.898 to 1.00) had the highest sensitivity) and CT the highest specificity (0.987, 95% CrI 0.958 to 1.00). VQ and VQ-SPECT had a higher proportion of indeterminate studies, while VQ and VQ-SPECT involved lower radiation exposure than CT. Conclusion: CPR and D-dimer testing can be used to avoid unnecessary imaging. CT is the most accurate single modality, but radiation risk must be assessed. These findings, in conjunction with a recent health technology assessment, may help to inform clinical practice and guidelines.

scholarly journals Validation and impact of a simplified clinical decision rule for diagnosing pulmonary embolism in primary care: design of the PECAN prospective diagnostic cohort management study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031639 ◽  
Author(s):  
Rosanne van Maanen ◽  
Frans H Rutten ◽  
Frederikus A Klok ◽  
Menno V Huisman ◽  
Jeanet W Blom ◽  
...  
Keyword(s):  
Primary Care ◽  
Pulmonary Embolism ◽  
False Negative ◽  
Diagnostic Algorithm ◽  
Clinical Decision ◽  
Final Diagnosis ◽  
Hospital Environment ◽  
Diagnostic Study ◽  
The Impact ◽  
D Dimer

IntroductionCombined with patient history and physical examination, a negative D-dimer can safely rule-out pulmonary embolism (PE). However, the D-dimer test is frequently false positive, leading to many (with hindsight) ‘unneeded’ referrals to secondary care. Recently, the novel YEARS algorithm, incorporating flexible D-dimer thresholds depending on pretest risk, was developed and validated, showing its ability to safely exclude PE in the hospital environment. Importantly, this was accompanied with 14% fewer computed tomographic pulmonary angiography than the standard, fixed D-dimer threshold. Although promising, in primary care this algorithm has not been validated yet.Methods and analysisThe PECAN (DiagnosingPulmonaryEmbolism in the context ofCommonAlternative diagNoses in primary care) study is a prospective diagnostic study performed in Dutch primary care. Included patients with suspected acute PE will be managed by their general practitioner according to the YEARS diagnostic algorithm and followed up in primary care for 3 months to establish the final diagnosis. To study the impact of the use of the YEARS algorithm, the primary endpoints are the safety and efficiency of the YEARS algorithm in primary care. Safety is defined as the proportion of false-negative test results in those not referred. Efficiency denotes the proportion of patients classified in this non-referred category. Additionally, we quantify whether C reactive protein measurement has added diagnostic value to the YEARS algorithm, using multivariable logistic and polytomous regression modelling. Furthermore, we will investigate which factors contribute to the subjective YEARS item ‘PE most likely diagnosis’.Ethics and disseminationThe study protocol was approved by the Medical Ethical Committee Utrecht, the Netherlands. Patients eligible for inclusion will be asked for their consent. Results will be disseminated by publication in peer-reviewed journals and presented at (inter)national meetings and congresses.Trial registrationNTR 7431.

Diagnosis: clinical prediction rules and laboratory tests

ESC CardioMed ◽  
2018 ◽  
pp. 2758-2761
Author(s):  
Piotr Pruszczyk
Keyword(s):  
Pulmonary Embolism ◽  
High Probability ◽  
Clinical Manifestations ◽  
High Sensitivity ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
D Dimer

Clinical manifestations of venous thromboembolism (VTE) usually are non-specific. In order to facilitate proper diagnosis, clinical prediction rules were derived. The best studied models are the Wells criteria for deep vein thrombosis and pulmonary embolism and the Geneva score for pulmonary embolism. They classify patients into different categories of clinical pretest VTE probability. Pulmonary embolism prevalence is approximately 10% in low-, 30% in moderate-, and up to 65% in high-probability categories. Plasma D-dimer levels are elevated in not only VTE but also in other conditions. A D-dimer assay should be used in combination with pretest VTE clinical probability. A normal high-sensitivity D-dimer level excludes pulmonary embolism in patients with low/intermediate or non-high VTE probability, while in the high probability category does not allow VTE to be safely excluded. Age-adjusted D-dimer thresholds (age × 10 μ‎g/L above 50 years) can limit the need for imaging methods without increasing the rate of missed diagnoses in non-high clinical probability patients.

Derivation of a Simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with the SimpliRED D-dimer

2000 ◽  
Vol 83 (03) ◽  
pp. 416-420 ◽  
Author(s):  
David Anderson ◽  
Marc Rodger ◽  
Jeffrey Ginsberg ◽  
Clive Kearon ◽  
Michael Gent ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Prediction Rule ◽  
Scoring Systems ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Clinical Model ◽  
Validation Set ◽  
D Dimer

SummaryWe have previously demonstrated that a clinical model can be safely used in a management strategy in patients with suspected pulmonary embolism (PE). We sought to simplify the clinical model and determine a scoring system, that when combined with D-dimer results, would safely exclude PE without the need for other tests, in a large proportion of patients. We used a randomly selected sample of 80% of the patients that participated in a prospective cohort study of patients with suspected PE to perform a logistic regression analysis on 40 clinical variables to create a simple clinical prediction rule. Cut points on the new rule were determined to create two scoring systems. In the first scoring system patients were classified as having low, moderate and high probability of PE with the proportions being similar to those determined in our original study. The second system was designed to create two categories, PE likely and unlikely. The goal in the latter was that PE unlikely patients with a negative D-dimer result would have PE in less than 2% of cases. The proportion of patients with PE in each category was determined overall and according to a positive or negative SimpliRED D-dimer result. After these determinations we applied the models to the remaining 20% of patients as a validation of the results. The following seven variables and assigned scores (in brackets) were included in the clinical prediction rule: Clinical symptoms of DVT (3.0), no alternative diagnosis (3.0), heart rate >100 (1.5), immobilization or surgery in the previous four weeks (1.5), previous DVT/PE (1.5), hemoptysis (1.0) and malignancy (1.0). Patients were considered low probability if the score was <2.0, moderate of the score was 2.0 to 6.0 and high if the score was over 6.0. Pulmonary embolism unlikely was assigned to patients with scores <4.0 and PE likely if the score was >4.0. 7.8% of patients with scores of less than or equal to 4 had PE but if the D-dimer was negative in these patients the rate of PE was only 2.2% (95% CI = 1.0% to 4.0%) in the derivation set and 1.7% in the validation set.Importantly this combination occurred in 46% of our study patients. A score of <2.0 and a negative D-dimer results in a PE rate of 1.5% (95% CI = 0.4% to 3.7%) in the derivation set and 2.7% (95% CI = 0.3% to 9.0%) in the validation set and only occurred in 29% of patients. The combination of a score <4.0 by our simple clinical prediction rule and a negative SimpliRED D-Dimer result may safely exclude PE in a large proportion of patients with suspected PE.

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