A structured clinical model for predicting the probability of pulmonary embolism
A structured clinical model for predicting the probability of pulmonary embolism
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DOI：
10.1016/s0002-9343(02)01478-x
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发表时间：
2003-02-15
影响因子：
5.9
通讯作者：
Bottai, M
中科院分区：
文献类型：
--
作者：
Miniati, M;Monti, S;Bottai, M
目得：建立一个结构化的模型来预测肺栓塞的临床概率。方法：我们研究了1100例连续的疑似肺栓塞患者，这些患者已经被确诊。我们使用逻辑回归分析来估计基于患者临床特征的肺栓塞的概率;概率被归类为低（小于或等于10%），中间（> 10%，小于或等于50%），中等偏高结果：440例患者中，肺栓塞的总患病率为40%（n = 440）。10个特征与肺栓塞风险增加相关（男性，年龄较大，血栓性静脉炎病史，突发性呼吸困难，胸痛，咯血，急性右心室超负荷的心电图体征，低血症的放射学体征，肺门动脉截肢和提示梗死的肺实变），5例与风险降低相关。（既往心血管或肺部疾病、高热、除梗死外的肺实变和胸片显示的肺水肿）。根据该模型，432例患者（39%）被评定为低概率，其中19例（4%）患有肺栓塞; 283例（26%）被评定为中等概率，其中62例（22%）患有肺栓塞; 72例（7%）被评定为中等高概率，其中53例（74%）患有肺栓塞; 313例（28%）被评定为高概率，其中306例（98%）有肺栓塞.结论：该预测模型可用于在获得明确的测试结果之前估计肺栓塞的概率. (C)2003年，Excerpta Medica Inc.
PURPOSE: To develop a structured model to predict the clinical probability of pulmonary embolism.METHODS: We studied 1100 consecutive patients with suspected pulmonary embolism in whom a definite diagnosis had been established. We used logistic regression analysis to estimate the probability of pulmonary embolism based on patients' clinical characteristics; the probability was categorized as low (less than or equal to 10%), intermediate (>10%, less than or equal to50%), moderately high (>50%, less than or equal to90%), or high (>90%).RESULTS: The overall prevalence of pulmonary embolism was 40% (n = 440). Ten characteristics were associated with an increased risk of pulmonary embolism (male sex, older age, history of thrombophlebitis, sudden-onset dyspnea, chest pain, hemoptysis, electrocardiographic signs of acute right ventricular overload, radiographic signs of oligemia, amputation of the hilar artery, and pulmonary consolidation suggestive of infarction), and five were associated with a decreased risk (prior cardiovascular or pulmonary disease, high fever, pulmonary consolidation other than infarction, and pulmonary edema on the chest radiograph). With this model, 432 patients (39%) were rated a low probability, of whom 19 (4%) had pulmonary em holism; 283 (26%) were rated an intermediate probability, of whom 62 (22%) had pulmonary embolism; 72 (7%) were rated a moderately high probability, of whom 53 (74%) had pulmonary embolism; and 313 (28%) were rated a high probability, of whom 306 (98%) had pulmonary embolism.CONCLUSION: This prediction model may be useful for estimating the probability of pulmonary embolism before obtaining definitive test results. (C) 2003 by Excerpta Medica Inc.