Use of a clinical model for safe management of patients with suspected pulmonary embolism
Use of a clinical model for safe management of patients with suspected pulmonary embolism
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DOI：
10.7326/0003-4819-129-12-199812150-00002
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发表时间：
1998-12-15
影响因子：
39.2
通讯作者：
Hirsh, J
中科院分区：
文献类型：
--
作者：
Wells, PS;Ginsberg, JS;Hirsh, J
背景资料：通气-灌注肺扫描的低特异性使疑似肺栓塞患者的管理复杂化。目的：确定疑似肺栓塞患者临床模型的安全性。设计：前瞻性队列研究。设置：5家三级护理医院。患者：1239例疑似肺栓塞的住院患者和门诊患者。干预措施：一个临床模型将肺栓塞的预测概率分为低、中、高，并进行通气灌注扫描和双侧深静脉超声检查。通过一系列超声检查，静脉造影，或血管造影检查取决于预测试概率和肺scans.Measurements：患者被认为是肺栓塞阳性，如果他们有一个异常的肺血管造影，异常的超声或静脉造影，高概率通气灌注扫描加上中度或高度预测试概率，或静脉血栓栓塞事件在3个月的随访。认为所有其他患者的肺栓塞均为阴性。在随访期间肺栓塞的患者谁有一个正常的肺扫描和那些有一个非高概率扫描和正常的序列ultrasound.Results的比率进行了比较：在734例患者（3.4%与肺栓塞），中度403（27.8%与肺栓塞），高102（78.4%与肺栓塞）的验前概率低。665名患者中有3名（0.5% [95%CI，0.1%至1.3%]），具有低或中等预检验概率和非高概率扫描，被认为肺栓塞阴性，在90天随访期间发生肺栓塞或深静脉血栓形成;这一比率与正常扫描的患者没有差异（0.6% [CI，0.1%至1.8%]; P > 0.2）。根据预测概率和通气灌注扫描结果对疑似肺栓塞患者进行管理是安全的。
Background: The low specificity of ventilation-perfusion lung scanning complicates the management of patients with suspected pulmonary embolism.Objective: To determine the safety of a clinical model for patients with suspected pulmonary embolism.Design: Prospective cohort study.Setting: Five tertiary care hospitals.Patients: 1239 inpatients and outpatients with suspected pulmonary embolism.Interventions: 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.Measurements: 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.Results: 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).Conclusion: Management of patients with suspected pulmonary embolism on the basis of pretest probability and results of ventilation-perfusion scanning is safe.