D-dimer threshold increase with pretest probability unlikely for pulmonary embolism to decrease unnecessary computerized tomographic pulmonary angiography.
D-dimer threshold increase with pretest probability unlikely for pulmonary embolism to decrease unnecessary computerized tomographic pulmonary angiography.
复制标题
D-二聚体阈值随着肺栓塞的不可能减少不必要的计算机断层扫描肺血管造影而增加。
DOI：
10.1111/j.1538-7836.2012.04647.x
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发表时间：
2012-04
期刊：
影响因子：
--
通讯作者：
Smithline HA
中科院分区：
文献类型：
--
作者：
Kline JA;Hogg MM;Courtney DM;Miller CD;Jones AE;Smithline HA
增加定义阳性D-二聚体的阈值可以减少不必要的CT肺血管造影（CTPA），但可能增加漏诊PE和漏诊肺炎的比率，这是CTPA上最常见的非血栓栓塞性诊断。测量标准D-二聚体阈值加倍对“不太可能发生PE”修订版日内瓦（RGS）或威尔斯评分的排除率、漏诊PE和漏诊肺炎的频率和大小的影响。从四家医院的急诊科和住院部前瞻性招募了64通道CTPA评估疑似PE的患者。在真实的时间内收集试验前概率数据，并在中心实验室测量D-二聚体。判定标准是由两名独立的放射科医生结合30天时的临床结局进行CPTA解释。在入组的678例患者中，126例（19%）为PE+，93例（14%）患有肺炎。使用威尔斯≤4或RGS≤6产生相似的结果。例如，RGS≤6和标准阈值（<500 ng/mL），110/678（16%）的D-二聚体为阴性，4/110为PE+（后验概率3.8%），9/110（8.2%）患有肺炎。当RGS≤6且阈值<1000 ng/mL时，208/678例（31%）D-二聚体为阴性，11/208例（5.3%）为PE+，但10/11例漏诊的PE为亚节段性，无合并DVT。RGS≤6和D-二聚体<1000 ng/mL的12/208例（5.4%）患者发现肺炎。将D-二聚体阳性的阈值加倍，PE不太可能的预检概率可以减少CTPA扫描，漏诊孤立亚段PE的风险略有增加，漏诊肺炎的比率没有增加。
Increasing the threshold to define a positive D-dimer could reduce unnecessary computed tomographic pulmonary angiography (CTPA) for suspected PE but might increase rates of missed PE and missed pneumonia, the most common nonthromboembolic diagnosis seen on CTPA. Measure the effect of doubling the standard D-dimer threshold for “PE unlikely” Revised Geneva (RGS) or Wells’ scores on the exclusion rate, frequency and size of missed PE and missed pneumonia. Patients evaluated for suspected PE with 64-channel CTPA were prospectively enrolled from EDs and inpatient units of four hospitals. Pretest probability data were collected in real time and the D-dimer was measured in a central laboratory. Criterion standard was CPTA interpretation by two independent radiologists combined with clinical outcome at 30 days. Of 678 patients enrolled, 126 (19%) were PE+ and 93 (14%) had pneumonia. Use of either Wells≤4 or RGS≤6 produced similar results. For example, with RGS≤6 and standard threshold (<500 ng/mL), D-dimer was negative in 110/678 (16%), and 4/110 were PE+ (posterior probability 3.8%), and 9/110 (8.2%) had pneumonia. With RGS≤6 and a threshold <1000 ng/mL, D-dimer was negative in 208/678 (31%) and 11/208 (5.3%) were PE+, but 10/11 missed PEs were subsegmental, and none had concomitant DVT. Pneumonia was found in 12/208 (5.4%) with RGS≤6 and D-dimer<1000 ng/mL. Doubling the threshold for a positive D-dimer with a PE unlikely pretest probability could reduce CTPA scanning with a slightly increased risk of missed isolated subsegmental PE, and no increase in rate of missed pneumonia.
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影响因子：
10.4
作者：
Courtney, D. M.;Miller, C.;Kline, J. A.
通讯作者：
Kline, J. A.
影响因子：
4.4
作者：
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影响因子：
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作者：
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影响因子：
5.9
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通讯作者：
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影响因子：
5.7
作者：
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通讯作者：
Kellum, John A.