TY - JOUR T1 - The bedside investigation of pulmonary embolism diagnosis study: a double-blind randomized controlled trial comparing combinations of 3 bedside tests vs ventilation-perfusion scan for the initial investigation of suspected pulmonary embolism. AU - Rodger,Marc A, AU - Bredeson,Christopher N, AU - Jones,Gwynne, AU - Rasuli,Pasteur, AU - Raymond,François, AU - Clement,Anne Marie, AU - Karovitch,Alan, AU - Brunette,Helene, AU - Makropoulos,Dimitri, AU - Reardon,Mark, AU - Stiell,Ian, AU - Nair,Rama, AU - Wells,Philip S, PY - 2006/1/25/pubmed PY - 2006/2/24/medline PY - 2006/1/25/entrez SP - 181 EP - 7 JF - Archives of internal medicine JO - Arch Intern Med VL - 166 IS - 2 N2 - BACKGROUND: We sought to determine whether using combinations of 3 bedside tests (7-variable clinical model, non-enzyme-linked immunosorbent assay D-dimer test, and alveolar dead-space fraction) to exclude pulmonary embolism (PE) before diagnostic imaging was as safe as a standard strategy of starting with ventilation-perfusion (V/Q) scan. METHODS: In this double-blind, randomized, controlled equivalency trial, patients were randomized to initial bedside tests or to initial V/Q scan without bedside tests. Patients assigned to the bedside test group had a sham V/Q scan performed if at least 2 of 3 bedside test results were negative; otherwise, they underwent an actual V/Q scan. Further diagnostic management was determined by a blinded physician after V/Q scan. The primary outcome measure was recurrent venous thromboembolic events during 3 months among patients who were not taking anticoagulant agents after the initial investigations were completed. RESULTS: Four hundred fifty-eight consecutive adults with suspected PE were eligible for the study; 398 of 399 consenting and randomized patients completed the study. The follow-up venous thromboembolic event rate was 2.4% in the bedside test group vs 3.0% in the V/Q scan group (P = .76). Pulmonary embolism was excluded in 34% (67/199) of the bedside test group patients with at least 2 negative results on 3 bedside tests vs 18% (35/199) excluded using only the 7-variable clinical model and the D-dimer test. CONCLUSION: Excluding PE with at least 2 negative results on 3 bedside tests safely eliminates the need for diagnostic imaging in 34% of patients with suspected PE. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/16432086/The_bedside_investigation_of_pulmonary_embolism_diagnosis_study:_a_double_blind_randomized_controlled_trial_comparing_combinations_of_3_bedside_tests_vs_ventilation_perfusion_scan_for_the_initial_investigation_of_suspected_pulmonary_embolism_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.166.2.181 DB - PRIME DP - Unbound Medicine ER -