Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study.

Content Provider	Semantic Scholar
Author	Perrier, A. Aujesky, Drahomir A. Chagnon, Isabelle Howarth, Nigel Gourdier, A. Leftheriotis, G. Barghouth, Ghassan Cornuz, Jacques Hayoz, Daniel Bounameaux, Henri
Copyright Year	2004
Abstract	PURPOSE To evaluate a diagnostic strategy for pulmonary embolism that combined clinical assessment, plasma D-dimer measurement, lower limb venous ultrasonography, and helical computed tomography (CT). METHODS A cohort of 965 consecutive patients presenting to the emergency departments of three general and teaching hospitals with clinically suspected pulmonary embolism underwent sequential noninvasive testing. Clinical probability was assessed by a prediction rule combined with implicit judgment. All patients were followed for 3 months. RESULTS A normal D-dimer level (<500 microg/L by a rapid enzyme-linked immunosorbent assay) ruled out venous thromboembolism in 280 patients (29%), and finding a deep vein thrombosis by ultrasonography established the diagnosis in 92 patients (9.5%). Helical CT was required in only 593 patients (61%) and showed pulmonary embolism in 124 patients (12.8%). Pulmonary embolism was considered ruled out in the 450 patients (46.6%) with a negative ultrasound and CT scan and a low-to-intermediate clinical probability. The 8 patients with a negative ultrasound and CT scan despite a high clinical probability proceeded to pulmonary angiography (positive: 2; negative: 6). Helical CT was inconclusive in 11 patients (pulmonary embolism: 4; no pulmonary embolism: 7). The overall prevalence of pulmonary embolism was 23%. Patients classified as not having pulmonary embolism were not anticoagulated during follow-up and had a 3-month thromboembolic risk of 1.0% (95% confidence interval: 0.5% to 2.1%). CONCLUSION A noninvasive diagnostic strategy combining clinical assessment, D-dimer measurement, ultrasonography, and helical CT yielded a diagnosis in 99% of outpatients suspected of pulmonary embolism, and appeared to be safe, provided that CT was combined with ultrasonography to rule out the disease.
File Format	PDF HTM / HTML
PubMed reference number	14984813
Journal	Medline
Volume Number	116
Issue Number	5
Alternate Webpage(s)	http://www.biomerieux-usa.com/sites/subsidiary_us/files/publication_perrier_ajm_2004.pdf
Alternate Webpage(s)	https://doi.org/10.1016/j.accreview.2004.04.085
Journal	The American journal of medicine
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article