Performance of 4 Clinical Decision Rules in the Diagnostic Management of Acute Pulmonary Embolism

2011 ◽  
Vol 154 (11) ◽  
pp. 709 ◽  
Author(s):  
Renée A. Douma
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Decision Rules ◽  
Clinical Decision ◽  
Clinical Decision Rules ◽  
Diagnostic Management

Safety and Clinical Utility of Four Clinical Decision Rules In the Diagnostic Management of Acute Pulmonary Embolism – the Prometheus Diagnosis Study

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 ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Utility ◽  
Acute Pulmonary Embolism ◽  
Decision Rules ◽  
Clinical Decision ◽  
Clinical Decision Rules ◽  
Wells Rule ◽  
Revised Geneva Score ◽  
Acute Pe ◽  
D Dimer

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.

Clinical Decision Rules and Patients With Acute Pulmonary Embolism

2015 ◽  
Vol 51 (4) ◽  
pp. 205
Author(s):  
Pedro Ruiz-Artacho ◽  
Matilde Rodríguez-Cerrillo ◽  
Natalia Marín ◽  
Francisco Javier Martín-Sánchez
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Decision Rules ◽  
Clinical Decision ◽  
Clinical Decision Rules

scholarly journals Consensus-derived clinical decision rules to guide advanced imaging decisions for pulmonary embolism in pregnancy and the postpartum period

2018 ◽  
Vol 25 (3) ◽  
pp. 221-222 ◽  
Author(s):  
Gordon W. Fuller ◽  
Catherine Nelson-Piercy ◽  
Beverley J. Hunt ◽  
Fiona E. Lecky ◽  
Steve Thomas ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Postpartum Period ◽  
Decision Rules ◽  
Clinical Decision ◽  
Advanced Imaging ◽  
Clinical Decision Rules ◽  
In Pregnancy

scholarly journals The Simplified Geneva Score and the Utilization of the D-Dimer and Computerized Tomography for Assessing Pulmonary Embolism

2011 ◽  
Vol 4 (4) ◽  
pp. 99-104
Author(s):  
John H Park ◽  
Cole R Spresser ◽  
Jorge A Valdivia ◽  
Michael J Khadavi ◽  
Saikat Das ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Decision Rules ◽  
Clinical Decision ◽  
Pulmonary Emboli ◽  
Clinical Decision Rules ◽  
Diagnostic Decision ◽  
Revised Geneva Score ◽  
Effective Use ◽  
Diagnostic Decision Making ◽  
D Dimer

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.

Clinical Decision Rules for Pulmonary Embolism in Hospitalized Patients: A Systematic Literature Review and Meta-analysis

2017 ◽  
Vol 117 (11) ◽  
pp. 2176-2185 ◽  
Author(s):  
Anne Bass ◽  
Kara Fields ◽  
Rie Goto ◽  
Gregory Turissini ◽  
Shirin Dey ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Decision Rules ◽  
Clinical Decision ◽  
Hospitalized Patients ◽  
Cochrane Library ◽  
Clinical Decision Rules ◽  
Wells Rule ◽  
D Dimer

Background Clinical decision rules (CDRs) for pulmonary embolism (PE) have been validated in outpatients, but their performance in hospitalized patients is not well characterized. Objectives The goal of this systematic literature review was to assess the performance of CDRs for PE in hospitalized patients. Methods We performed a structured literature search using Medline, EMBASE and the Cochrane library for articles published on or before January 18, 2017. Two authors reviewed all titles, abstracts and full texts. We selected prospective studies of symptomatic hospitalized patients in which a CDR was used to estimate the likelihood of PE. The diagnosis of PE had to be confirmed using an accepted reference standard. Data on hospitalized patients were solicited from authors of studies in mixed populations of outpatients and hospitalized patients. Study characteristics, PE prevalence and CDR performance were extracted. The methodological quality of the studies was assessed using the QUADAS instrument. Results Twelve studies encompassing 3,942 hospitalized patients were included. Studies varied in methodology (randomized controlled trials and observational studies) and reference standards used. The pooled sensitivity of the modified Wells rule (cut-off ≤ 4) in hospitalized patients was 72.1% (95% confidence interval [CI], 63.7–79.2) and the pooled specificity was 62.2% (95% CI, 52.6–70.9). The modified Wells rule (cut-off ≤ 4) plus D-dimer testing had a pooled sensitivity 99.7% (95% CI, 96.7–100) and pooled specificity 10.8% (95% CI, 6.7–16.9). The efficiency (proportion of patients stratified into the ‘PE unlikely’ group) was 8.4% (95% CI, 4.1–16.5), and the failure rate (proportion of low likelihood patients who were diagnosed with PE during follow-up) was 0.1% (95% CI, 0–5.3). Conclusion In symptomatic hospitalized patients, use of the Wells rule plus D-dimer to rule out PE is safe, but allows very few patients to forgo imaging.

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