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Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study.
Am J Med 2004; 116(5):291-9AJ

Abstract

PURPOSE

To evaluate a diagnostic strategy for pulmonary embolism that combined clinical assessment, plasma D-dimer measurement, lower limb venous ultrasonography, and helical computed tomography (CT).

METHODS

A cohort of 965 consecutive patients presenting to the emergency departments of three general and teaching hospitals with clinically suspected pulmonary embolism underwent sequential noninvasive testing. Clinical probability was assessed by a prediction rule combined with implicit judgment. All patients were followed for 3 months.

RESULTS

A normal D-dimer level (<500 microg/L by a rapid enzyme-linked immunosorbent assay) ruled out venous thromboembolism in 280 patients (29%), and finding a deep vein thrombosis by ultrasonography established the diagnosis in 92 patients (9.5%). Helical CT was required in only 593 patients (61%) and showed pulmonary embolism in 124 patients (12.8%). Pulmonary embolism was considered ruled out in the 450 patients (46.6%) with a negative ultrasound and CT scan and a low-to-intermediate clinical probability. The 8 patients with a negative ultrasound and CT scan despite a high clinical probability proceeded to pulmonary angiography (positive: 2; negative: 6). Helical CT was inconclusive in 11 patients (pulmonary embolism: 4; no pulmonary embolism: 7). The overall prevalence of pulmonary embolism was 23%. Patients classified as not having pulmonary embolism were not anticoagulated during follow-up and had a 3-month thromboembolic risk of 1.0% (95% confidence interval: 0.5% to 2.1%).

CONCLUSION

A noninvasive diagnostic strategy combining clinical assessment, D-dimer measurement, ultrasonography, and helical CT yielded a diagnosis in 99% of outpatients suspected of pulmonary embolism, and appeared to be safe, provided that CT was combined with ultrasonography to rule out the disease.

Authors+Show Affiliations

Medical Clinic 1, Geneva University Hospital, Switzerland. Arnaud.Perrier@hcuge.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14984813

Citation

Perrier, Arnaud, et al. "Diagnosing Pulmonary Embolism in Outpatients With Clinical Assessment, D-dimer Measurement, Venous Ultrasound, and Helical Computed Tomography: a Multicenter Management Study." The American Journal of Medicine, vol. 116, no. 5, 2004, pp. 291-9.
Perrier A, Roy PM, Aujesky D, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. 2004;116(5):291-9.
Perrier, A., Roy, P. M., Aujesky, D., Chagnon, I., Howarth, N., Gourdier, A. L., ... Bounameaux, H. (2004). Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. The American Journal of Medicine, 116(5), pp. 291-9.
Perrier A, et al. Diagnosing Pulmonary Embolism in Outpatients With Clinical Assessment, D-dimer Measurement, Venous Ultrasound, and Helical Computed Tomography: a Multicenter Management Study. Am J Med. 2004 Mar 1;116(5):291-9. PubMed PMID: 14984813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. AU - Perrier,Arnaud, AU - Roy,Pierre-Marie, AU - Aujesky,Drahomir, AU - Chagnon,Isabelle, AU - Howarth,Nigel, AU - Gourdier,Anne-Laurence, AU - Leftheriotis,Georges, AU - Barghouth,Ghassan, AU - Cornuz,Jacques, AU - Hayoz,Daniel, AU - Bounameaux,Henri, PY - 2003/06/02/received PY - 2003/09/11/revised PY - 2003/09/11/accepted PY - 2004/2/27/pubmed PY - 2004/3/10/medline PY - 2004/2/27/entrez SP - 291 EP - 9 JF - The American journal of medicine JO - Am. J. Med. VL - 116 IS - 5 N2 - PURPOSE: To evaluate a diagnostic strategy for pulmonary embolism that combined clinical assessment, plasma D-dimer measurement, lower limb venous ultrasonography, and helical computed tomography (CT). METHODS: A cohort of 965 consecutive patients presenting to the emergency departments of three general and teaching hospitals with clinically suspected pulmonary embolism underwent sequential noninvasive testing. Clinical probability was assessed by a prediction rule combined with implicit judgment. All patients were followed for 3 months. RESULTS: A normal D-dimer level (<500 microg/L by a rapid enzyme-linked immunosorbent assay) ruled out venous thromboembolism in 280 patients (29%), and finding a deep vein thrombosis by ultrasonography established the diagnosis in 92 patients (9.5%). Helical CT was required in only 593 patients (61%) and showed pulmonary embolism in 124 patients (12.8%). Pulmonary embolism was considered ruled out in the 450 patients (46.6%) with a negative ultrasound and CT scan and a low-to-intermediate clinical probability. The 8 patients with a negative ultrasound and CT scan despite a high clinical probability proceeded to pulmonary angiography (positive: 2; negative: 6). Helical CT was inconclusive in 11 patients (pulmonary embolism: 4; no pulmonary embolism: 7). The overall prevalence of pulmonary embolism was 23%. Patients classified as not having pulmonary embolism were not anticoagulated during follow-up and had a 3-month thromboembolic risk of 1.0% (95% confidence interval: 0.5% to 2.1%). CONCLUSION: A noninvasive diagnostic strategy combining clinical assessment, D-dimer measurement, ultrasonography, and helical CT yielded a diagnosis in 99% of outpatients suspected of pulmonary embolism, and appeared to be safe, provided that CT was combined with ultrasonography to rule out the disease. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/14984813/Diagnosing_pulmonary_embolism_in_outpatients_with_clinical_assessment_D_dimer_measurement_venous_ultrasound_and_helical_computed_tomography:_a_multicenter_management_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002934303007174 DB - PRIME DP - Unbound Medicine ER -