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Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries. A multicentre clinical outcome study.

Abstract

The objective of the study was to assess the clinical validity of a non-invasive diagnostic strategy for acute pulmonary embolism using clinical assessment combined with both ELISA D-dimer and complete lower limb ultrasound (US) examination of proximal and distal veins, before single-detector helical computed tomography (CT) of pulmonary arteries. We expected the strategy to have a high diagnostic exclusion power and to safely decrease the number of CT scans. This prospective, multicenter outcome study included 274 consecutive outpatients. All underwent a priori clinical probability, D-dimer and bilateral complete lower limb US assessments. Only patients with a high clinical probability and both tests negative, or positive D-dimer and negative US assessments, underwent CT. This was deemed necessary in 114 patients (42%). At baseline, venous thromboembolism (VTE) was detected in 110 patients (40%), either by US showing proximal (n=65) or distal (n=36) thrombosis, or by CT (n=9). Anticoagulant was withheld in the remaining patients with negative results in both D-dimer and US but a non-high clinical probability (n=59), or in both US and CT (n=90), or with negative US (n=6) and inadequate CT (n=9). All patients underwent a three-month clinical follow-up. VTE occurred in one patient with inadequate CT, yielding an incidence of 0.6% [95% confidence interval: 0.1-3.4]. No patient died from VTE or had major bleeding. Using clinical probability, ELISA D-dimer and complete US before helical CT is a safe strategy resulting in a substantial reduction in CT scans.

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  • Authors+Show Affiliations

    ,

    Department of Vascular Medicine, Rangueil University Hospital Centre, Toulouse, France. elias.a@chu-toulouse.fr

    , , , , , , , , , , , ,

    Source

    Thrombosis and haemostasis 93:5 2005 May pg 982-8

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Anticoagulants
    Enzyme-Linked Immunosorbent Assay
    Female
    Fibrin Fibrinogen Degradation Products
    Follow-Up Studies
    Humans
    Lower Extremity
    Male
    Middle Aged
    Prospective Studies
    Pulmonary Artery
    Pulmonary Embolism
    Reproducibility of Results
    Thromboembolism
    Thrombosis
    Time Factors
    Tomography, Spiral Computed
    Treatment Outcome
    Ultrasonography
    Veins
    Venous Thrombosis

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    15886818

    Citation

    Elias, Antoine, et al. "Diagnostic Management of Pulmonary Embolism Using Clinical Assessment, Plasma D-dimer Assay, Complete Lower Limb Venous Ultrasound and Helical Computed Tomography of Pulmonary Arteries. a Multicentre Clinical Outcome Study." Thrombosis and Haemostasis, vol. 93, no. 5, 2005, pp. 982-8.
    Elias A, Cazanave A, Elias M, et al. Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries. A multicentre clinical outcome study. Thromb Haemost. 2005;93(5):982-8.
    Elias, A., Cazanave, A., Elias, M., Chabbert, V., Juchet, H., Paradis, H., ... Rousseau, H. (2005). Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries. A multicentre clinical outcome study. Thrombosis and Haemostasis, 93(5), pp. 982-8.
    Elias A, et al. Diagnostic Management of Pulmonary Embolism Using Clinical Assessment, Plasma D-dimer Assay, Complete Lower Limb Venous Ultrasound and Helical Computed Tomography of Pulmonary Arteries. a Multicentre Clinical Outcome Study. Thromb Haemost. 2005;93(5):982-8. PubMed PMID: 15886818.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries. A multicentre clinical outcome study. AU - Elias,Antoine, AU - Cazanave,Alain, AU - Elias,Marie, AU - Chabbert,Valérie, AU - Juchet,Henri, AU - Paradis,Hélène, AU - Carrière,Philippe, AU - Nguyen,Françoise, AU - Didier,Alain, AU - Galinier,Michel, AU - Colin,Cyrille, AU - Lauque,Dominique, AU - Joffre,Francis, AU - Rousseau,Hervé, PY - 2005/5/12/pubmed PY - 2005/8/20/medline PY - 2005/5/12/entrez SP - 982 EP - 8 JF - Thrombosis and haemostasis JO - Thromb. Haemost. VL - 93 IS - 5 N2 - The objective of the study was to assess the clinical validity of a non-invasive diagnostic strategy for acute pulmonary embolism using clinical assessment combined with both ELISA D-dimer and complete lower limb ultrasound (US) examination of proximal and distal veins, before single-detector helical computed tomography (CT) of pulmonary arteries. We expected the strategy to have a high diagnostic exclusion power and to safely decrease the number of CT scans. This prospective, multicenter outcome study included 274 consecutive outpatients. All underwent a priori clinical probability, D-dimer and bilateral complete lower limb US assessments. Only patients with a high clinical probability and both tests negative, or positive D-dimer and negative US assessments, underwent CT. This was deemed necessary in 114 patients (42%). At baseline, venous thromboembolism (VTE) was detected in 110 patients (40%), either by US showing proximal (n=65) or distal (n=36) thrombosis, or by CT (n=9). Anticoagulant was withheld in the remaining patients with negative results in both D-dimer and US but a non-high clinical probability (n=59), or in both US and CT (n=90), or with negative US (n=6) and inadequate CT (n=9). All patients underwent a three-month clinical follow-up. VTE occurred in one patient with inadequate CT, yielding an incidence of 0.6% [95% confidence interval: 0.1-3.4]. No patient died from VTE or had major bleeding. Using clinical probability, ELISA D-dimer and complete US before helical CT is a safe strategy resulting in a substantial reduction in CT scans. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/15886818/full_citation L2 - http://www.thieme-connect.com/DOI/DOI?10.1160/TH04-11-0734 DB - PRIME DP - Unbound Medicine ER -