Clinical probability and D-dimer testing: how should we use them in clinical practice?
Clinical probability and D-dimer testing: how should we use them in clinical practice?
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DOI：
10.1055/s-2008-1047559
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发表时间：
2008-02
影响因子：
3.2
通讯作者：
C. W. Hargett;V. Tapson
中科院分区：
文献类型：
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作者：
C. W. Hargett;V. Tapson
静脉血栓栓塞症（VTE）极为常见，是发病和死亡的主要原因。然而，其多样的临床表现使VTE的准确及时诊断变得复杂。临床预测规则（CPRs）和D - 二聚体检测越来越多地被用于明确此类病例所需的复杂决策。正式的临床验前概率现在是诊断深静脉血栓形成（DVT）和肺栓塞（PE）算法的基础。VTE的低验前概率加上D - 二聚体阴性，可以贝叶斯方式相结合，有效地排除VTE的诊断。这种策略的证据在无相关合并症、无VTE既往史且症状持续时间短的年轻门诊患者中最为有力。
Venous thromboembolism (VTE) is extraordinarily common and is a major cause of morbidity and mortality. However, accurate and timely diagnosis of VTE is confounded by its kaleidoscopic presentation. Clinical prediction rules (CPRs) and D-dimer testing have both been increasingly employed to clarify the complex decision making required in such cases. Formal clinical pretest probability now serves as the root of algorithms for the diagnosis of DVT and PE. A low pretest probability of VTE plus a negative D dimer can be combined in a bayesian fashion to effectively exclude the diagnosis of VTE. The evidence for this strategy is strongest in younger outpatients with no associated comorbidities, no prior history of VTE, and a short duration of symptoms.