The utility of pretest probability assessment in patients with clinically suspected venous thromboembolism
The utility of pretest probability assessment in patients with clinically suspected venous thromboembolism
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预测概率评估在临床疑似静脉血栓栓塞患者中的应用
DOI：
10.1046/j.1538-7836.2003.00382.x
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发表时间：
2003
影响因子：
10.4
通讯作者：
B. Hunt
中科院分区：
文献类型：
--
作者：
J. Kelly;B. Hunt
摘要 对预检验概率（PTP）进行评估，并将其分为低风险、中等风险和高风险组，这是当前疑似静脉血栓栓塞（VTE）患者诊断管理的重要初始步骤。结合其他信息，它减少了对初始和补充成像的需求，并允许在非侵入性成像后对VTE的后验概率进行相当大的改进。PTP可以通过经验或使用各种决策规则或评分系统进行评估，其中最知名的是疑似深静脉血栓形成（DVT）和肺栓塞（PE）的简化威尔斯评分，以及疑似PE的日内瓦评分。这些方法中的每一种都显示出类似的方向和分类准确性，并且已经被验证为促进PTP的临床有用分类，尽管数据概述表明，当经验评估时，较少的患者倾向于被归类为低PTP。这一组是最重要的识别，因为几项结局研究表明，在疑似DVT或PE的门诊患者中安全地避免了成像和治疗，这些患者的PTP较低，并且d-二聚体检测阴性，这一亚组占所有研究患者的一半。因此，虽然可能不是至关重要的，但评分系统提供的明确方法可能比经验评估更可取，特别是在较初级的工作人员使用时。
Summary. The assessment of pretest probability (PTP), with stratification into low‐, intermediate‐ and high‐risk groups is an essential initial step in the current diagnostic management of patients with suspected venous thromboembolism (VTE). In combination with additional information, it reduces the need for initial and supplementary imaging, and allows considerable refinement of the posterior probability of VTE following non‐invasive imaging. PTP may be assessed either empirically or by using various decision rules or scoring systems, the best known of which are the simplified Wells scores for suspected deep vein thrombosis (DVT) and pulmonary embolism (PE), and the Geneva score for suspected PE. Each of these approaches shows similar directional and categorical accuracy, and has been validated as facilitating clinically useful classification of the PTP, although an overview of data suggests that fewer patients tend to be classified as low PTP when assessed empirically. This group is the most important to identify, as several outcome studies have shown that imaging and treatment are safely obviated in outpatients with suspected DVT or PE who have a low PTP in combination with negative d‐dimer testing, a subgroup accounting for up to half of all patients studied. Hence, while probably not of critical importance, the explicit approach offered by scoring systems might be preferred over empirical assessment, particularly when used by more junior staff.
影响因子：
39.2
作者：
Wells, PS;Anderson, DR;Kovacs, MJ
通讯作者：
Kovacs, MJ