HOMEPRODUCTSSERVICESCOMPANYCONTACTFAQResearchDictionaryPharmaMobileSign Up FREE or Login

Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography.

AbstractCONTEXT:
Previous studies have evaluated the safety of relatively complex combinations of clinical decision rules and diagnostic tests in patients with suspected pulmonary embolism.
OBJECTIVE:
To assess the clinical effectiveness of a simplified algorithm using a dichotomized clinical decision rule, D-dimer testing, and computed tomography (CT) in patients with suspected pulmonary embolism.
DESIGN, SETTING, AND PATIENTS:
Prospective cohort study of consecutive patients with clinically suspected acute pulmonary embolism, conducted in 12 centers in the Netherlands from November 2002 through December 2004. The study population of 3306 patients included 82% outpatients and 57% women.
INTERVENTIONS:
Patients were categorized as "pulmonary embolism unlikely" or "pulmonary embolism likely" using a dichotomized version of the Wells clinical decision rule. Patients classified as unlikely had D-dimer testing, and pulmonary embolism was considered excluded if the D-dimer test result was normal. All other patients underwent CT, and pulmonary embolism was considered present or excluded based on the results. Anticoagulants were withheld from patients classified as excluded, and all patients were followed up for 3 months.
MAIN OUTCOME MEASURE:
Symptomatic or fatal venous thromboembolism (VTE) during 3-month follow-up.
RESULTS:
Pulmonary embolism was classified as unlikely in 2206 patients (66.7%). The combination of pulmonary embolism unlikely and a normal D-dimer test result occurred in 1057 patients (32.0%), of whom 1028 were not treated with anticoagulants; subsequent nonfatal VTE occurred in 5 patients (0.5% [95% confidence interval {CI}, 0.2%-1.1%]). Computed tomography showed pulmonary embolism in 674 patients (20.4%). Computed tomography excluded pulmonary embolism in 1505 patients, of whom 1436 patients were not treated with anticoagulants; in these patients the 3-month incidence of VTE was 1.3% (95% CI, 0.7%-2.0%). Pulmonary embolism was considered a possible cause of death in 7 patients after a negative CT scan (0.5% [95% CI, 0.2%-1.0%]). The algorithm was completed and allowed a management decision in 97.9% of patients.
CONCLUSIONS:
A diagnostic management strategy using a simple clinical decision rule, D-dimer testing, and CT is effective in the evaluation and management of patients with clinically suspected pulmonary embolism. Its use is associated with low risk for subsequent fatal and nonfatal VTE.
AuthorsArne van Belle, Harry R Büller, Menno V Huisman, Peter M Huisman, Karin Kaasjager, Pieter W Kamphuisen, Mark H H Kramer, Marieke J H A Kruip, Johanna M Kwakkel-van Erp, Frank W G Leebeek, Mathilde Nijkeuter, Martin H Prins, Maaike Sohne, Lidwine W Tick,
JournalJAMA (JAMA) Vol. 295 Issue 2 Pg. 172-9 (Jan 11 2006) ISSN: 1538-3598 [Electronic] United States
PMID16403929 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
Chemical References
  • Anticoagulants
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
Topics
  • Adult
  • Aged
  • Algorithms
  • Anticoagulants (therapeutic use)
  • Decision Theory
  • Female
  • Fibrin Fibrinogen Degradation Products (analysis)
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Embolism (blood, complications, diagnosis, drug therapy)
  • Thromboembolism (complications, prevention & control)
  • Tomography, X-Ray Computed

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research network!


Choose Username:
Email:
Password:
Verify Password: