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The rehabilitation of clinical assessment for the diagnosis of pulmonary embolism.
Semin Vasc Med. 2002 Nov; 2(4):345-51.SV

Abstract

Pulmonary angiography is the gold standard for diagnosis of segmental pulmonary embolism, but no longer for subsegmental pulmonary embolism because the inter-observer agreement for angiographically documented subsegmental pulmonary embolism is only 60%. A normal rapid ELISA VIDAS D-dimer test result and a normal perfusion scan exclude pulmonary embolism with a negative predictive value of >99%, irrespective of clinical score. The positive predictive value for pulmonary embolism of a high probability VP-scan compared to pulmonary angiography is 87% indicating that 13% of patients with a high probability VP-scan do not have pulmonary embolism. The combination of a negative CUS, a low clinical score, and a non-diagnostic VP-scan safely excludes pulmonary embolism. Patients with a non-diagnostic VP-scan, a negative CUS, but a moderate to high clinical score are candidates for pulmonary angiography. The positive predictive value of helical spiral CT is >95 to 99%. The combination of a negative CUS, a low clinical score, and the presence of a clear alternative diagnosis is predicted to safely exclude pulmonary embolism. Helical spiral CT detects all clinical relevant pulmonary emboli and a large number of alternative diagnoses in symptomatic patients with a non-diagnostic or a high-probability VP-scan. The negative predictive value during 3 months followup after a negative spiral CT for pulmonary embolism in 4 retrospective studies and 1 prospective management study was >99%. Only a small group of patients (1-2%) with a non-diagnostic spiral CT are candidates for pulmonary angiography. Therefore, it is predicted that the spiral CT will replace both VP-scanning and pulmonary angiography to safely exclude or diagnose pulmonary emboli in patients with suspected pulmonary embolism.

Authors

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Pub Type(s)

Editorial
Review

Language

eng

PubMed ID

16222624

Citation

Michiels, Jan Jacques, et al. "The Rehabilitation of Clinical Assessment for the Diagnosis of Pulmonary Embolism." Seminars in Vascular Medicine, vol. 2, no. 4, 2002, pp. 345-51.
Michiels JJ, Berghout A, Schroyens W, et al. The rehabilitation of clinical assessment for the diagnosis of pulmonary embolism. Semin Vasc Med. 2002;2(4):345-51.
Michiels, J. J., Berghout, A., Schroyens, W., De Backer, W., Hoogsteden, H., & Pattynama, P. M. (2002). The rehabilitation of clinical assessment for the diagnosis of pulmonary embolism. Seminars in Vascular Medicine, 2(4), 345-51.
Michiels JJ, et al. The Rehabilitation of Clinical Assessment for the Diagnosis of Pulmonary Embolism. Semin Vasc Med. 2002;2(4):345-51. PubMed PMID: 16222624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The rehabilitation of clinical assessment for the diagnosis of pulmonary embolism. AU - Michiels,Jan Jacques, AU - Berghout,Ari, AU - Schroyens,Wilfried, AU - De Backer,Wilfried, AU - Hoogsteden,Henk, AU - Pattynama,Peter M T, PY - 2005/10/14/pubmed PY - 2005/11/9/medline PY - 2005/10/14/entrez SP - 345 EP - 51 JF - Seminars in vascular medicine JO - Semin Vasc Med VL - 2 IS - 4 N2 - Pulmonary angiography is the gold standard for diagnosis of segmental pulmonary embolism, but no longer for subsegmental pulmonary embolism because the inter-observer agreement for angiographically documented subsegmental pulmonary embolism is only 60%. A normal rapid ELISA VIDAS D-dimer test result and a normal perfusion scan exclude pulmonary embolism with a negative predictive value of >99%, irrespective of clinical score. The positive predictive value for pulmonary embolism of a high probability VP-scan compared to pulmonary angiography is 87% indicating that 13% of patients with a high probability VP-scan do not have pulmonary embolism. The combination of a negative CUS, a low clinical score, and a non-diagnostic VP-scan safely excludes pulmonary embolism. Patients with a non-diagnostic VP-scan, a negative CUS, but a moderate to high clinical score are candidates for pulmonary angiography. The positive predictive value of helical spiral CT is >95 to 99%. The combination of a negative CUS, a low clinical score, and the presence of a clear alternative diagnosis is predicted to safely exclude pulmonary embolism. Helical spiral CT detects all clinical relevant pulmonary emboli and a large number of alternative diagnoses in symptomatic patients with a non-diagnostic or a high-probability VP-scan. The negative predictive value during 3 months followup after a negative spiral CT for pulmonary embolism in 4 retrospective studies and 1 prospective management study was >99%. Only a small group of patients (1-2%) with a non-diagnostic spiral CT are candidates for pulmonary angiography. Therefore, it is predicted that the spiral CT will replace both VP-scanning and pulmonary angiography to safely exclude or diagnose pulmonary emboli in patients with suspected pulmonary embolism. SN - 1528-9648 UR - https://www.unboundmedicine.com/medline/citation/16222624/The_rehabilitation_of_clinical_assessment_for_the_diagnosis_of_pulmonary_embolism_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=16222624.ui DB - PRIME DP - Unbound Medicine ER -