Tags

Type your tag names separated by a space and hit enter

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):982-8TH

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.

Authors+Show Affiliations

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

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 -