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- Title
Use of a clinical model for safe management of patients with suspected pulmonary embolism.
- Authors
Wells, Philip S.; Ginsberg, Jeffrey S.; Wells, P S; Ginsberg, J S; Anderson, D R; Kearon, C; Gent, M; Turpie, A G; Bormanis, J; Weitz, J; Chamberlain, M; Bowie, D; Barnes, D; Hirsh, J
- Abstract
<bold>Background: </bold>The low specificity of ventilation-perfusion lung scanning complicates the management of patients with suspected pulmonary embolism.<bold>Objective: </bold>To determine the safety of a clinical model for patients with suspected pulmonary embolism.<bold>Design: </bold>Prospective cohort study.<bold>Setting: </bold>Five tertiary care hospitals.<bold>Patients: </bold>1239 inpatients and outpatients with suspected pulmonary embolism.<bold>Interventions: </bold>A clinical model categorized pretest probability of pulmonary embolism as low, moderate, or high, and ventilation-perfusion scanning and bilateral deep venous ultrasonography were done. Testing by serial ultrasonography, venography, or angiography depended on pretest probability and lung scans.<bold>Measurements: </bold>Patients were considered positive for pulmonary embolism if they had an abnormal pulmonary angiogram, abnormal ultrasonogram or venogram, high-probability ventilation-perfusion scan plus moderate or high pretest probability, or venous thromboembolic event during the 3-month follow-up. All other patients were considered negative for pulmonary embolism. Rates of pulmonary embolism during follow-up in patients who had a normal lung scan and those with a non-high-probability scan and normal serial ultrasonogram were compared.<bold>Results: </bold>Pretest probability was low in 734 patients (3.4% with pulmonary embolism), moderate in 403 (27.8% with pulmonary embolism), and high in 102 (78.4% with pulmonary embolism). Three of the 665 patients (0.5% [95% CI, 0.1% to 1.3%]) with low or moderate pretest probability and a non-high-probability scan who were considered negative for pulmonary embolism had pulmonary embolism or deep venous thrombosis during 90-day follow-up; this rate did not differ from that in patients with a normal scan (0.6% [CI, 0.1% to 1.8%]; P > 0.2).<bold>Conclusion: </bold>Management of patients with suspected pulmonary embolism on the basis of pretest probability and results of ventilation-perfusion scanning is safe.
- Subjects
PULMONARY embolism; MEDICAL screening; PATIENTS
- Publication
Annals of Internal Medicine, 1998, Vol 129, Issue 12, p997
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-129-12-199812150-00002