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A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism.
J Intern Med. 2006 Nov; 260(5):459-66.JI

Abstract

OBJECTIVES

Diagnostic strategies in patients with suspected pulmonary embolism have been extensively studied in outpatients; their value in hospitalized patients has not been well established. Our aim was to determine the safety and clinical utility of a simple diagnostic strategy in hospitalized patients with suspected pulmonary embolism.

DESIGN

Prospective management study.

SETTING

Twelve teaching hospitals (five academic, seven general hospitals).

SUBJECT

A total of 605 hospitalized patients with clinically suspected pulmonary embolism. All patients completed the study.

INTERVENTIONS

First the clinical decision rule (CDR)-score was calculated. An unlikely CDR-score in combination with a normal D-dimer excluded pulmonary embolism. All other patients underwent helical computed tomography (CT). CT either diagnosed or excluded pulmonary embolism, in which case anticoagulants were started or withheld. All patients were instructed to report symptoms of venous thrombosis. Objective tests were performed to confirm venous thromboembolism. The primary outcome was the incidence of symptomatic venous thrombosis during 3-month follow-up.

RESULTS

The combination of an unlikely CDR-score and a normal D-dimer excluded pulmonary embolism in 60 patients (10% of all patients); no venous thromboembolic event occurred during follow-up (0%; 95% CI 0-6.7%). CT excluded pulmonary embolism in 380 patients; during follow-up venous thromboembolism occurred in five patients (1.4%; 95% CI 0.4-3.1%).

CONCLUSIONS

An unlikely CDR-score in combination with a normal D-dimer appears to exclude pulmonary embolism safely in hospitalized patients. Before clinical implementation it is important this safety is confirmed by others. CT testing was obviated in only 10% of patients. CT can safely exclude pulmonary embolism in hospitalized patients.

Authors+Show Affiliations

Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands. m.kruip@erasmusmc.nlNo 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

17040252

Citation

Kruip, M J H A., et al. "A Simple Diagnostic Strategy in Hospitalized Patients With Clinically Suspected Pulmonary Embolism." Journal of Internal Medicine, vol. 260, no. 5, 2006, pp. 459-66.
Kruip MJ, Söhne M, Nijkeuter M, et al. A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism. J Intern Med. 2006;260(5):459-66.
Kruip, M. J., Söhne, M., Nijkeuter, M., Kwakkel-Van Erp, H. M., Tick, L. W., Halkes, S. J., Prins, M. H., Kramer, M. H., Huisman, M. V., Büller, H. R., & Leebeek, F. W. (2006). A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism. Journal of Internal Medicine, 260(5), 459-66.
Kruip MJ, et al. A Simple Diagnostic Strategy in Hospitalized Patients With Clinically Suspected Pulmonary Embolism. J Intern Med. 2006;260(5):459-66. PubMed PMID: 17040252.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism. AU - Kruip,M J H A, AU - Söhne,M, AU - Nijkeuter,M, AU - Kwakkel-Van Erp,H M, AU - Tick,L W, AU - Halkes,S J M, AU - Prins,M H, AU - Kramer,M H H, AU - Huisman,M V, AU - Büller,H R, AU - Leebeek,F W G, AU - ,, PY - 2006/10/17/pubmed PY - 2007/3/16/medline PY - 2006/10/17/entrez SP - 459 EP - 66 JF - Journal of internal medicine JO - J. Intern. Med. VL - 260 IS - 5 N2 - OBJECTIVES: Diagnostic strategies in patients with suspected pulmonary embolism have been extensively studied in outpatients; their value in hospitalized patients has not been well established. Our aim was to determine the safety and clinical utility of a simple diagnostic strategy in hospitalized patients with suspected pulmonary embolism. DESIGN: Prospective management study. SETTING: Twelve teaching hospitals (five academic, seven general hospitals). SUBJECT: A total of 605 hospitalized patients with clinically suspected pulmonary embolism. All patients completed the study. INTERVENTIONS: First the clinical decision rule (CDR)-score was calculated. An unlikely CDR-score in combination with a normal D-dimer excluded pulmonary embolism. All other patients underwent helical computed tomography (CT). CT either diagnosed or excluded pulmonary embolism, in which case anticoagulants were started or withheld. All patients were instructed to report symptoms of venous thrombosis. Objective tests were performed to confirm venous thromboembolism. The primary outcome was the incidence of symptomatic venous thrombosis during 3-month follow-up. RESULTS: The combination of an unlikely CDR-score and a normal D-dimer excluded pulmonary embolism in 60 patients (10% of all patients); no venous thromboembolic event occurred during follow-up (0%; 95% CI 0-6.7%). CT excluded pulmonary embolism in 380 patients; during follow-up venous thromboembolism occurred in five patients (1.4%; 95% CI 0.4-3.1%). CONCLUSIONS: An unlikely CDR-score in combination with a normal D-dimer appears to exclude pulmonary embolism safely in hospitalized patients. Before clinical implementation it is important this safety is confirmed by others. CT testing was obviated in only 10% of patients. CT can safely exclude pulmonary embolism in hospitalized patients. SN - 0954-6820 UR - https://www.unboundmedicine.com/medline/citation/17040252/A_simple_diagnostic_strategy_in_hospitalized_patients_with_clinically_suspected_pulmonary_embolism_ L2 - https://doi.org/10.1111/j.1365-2796.2006.01709.x DB - PRIME DP - Unbound Medicine ER -