Clinical probability score and D-dimer estimation lack utility in the diagnosis of childhood pulmonary embolism
Clinical probability score and D-dimer estimation lack utility in the diagnosis of childhood pulmonary embolism
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DOI：
10.1111/j.1538-7836.2009.03572.x
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发表时间：
2009-10-01
影响因子：
10.4
通讯作者：
Williams, S.
中科院分区：
文献类型：
--
作者：
Biss, T. T.;Brandao, L. R.;Williams, S.
背景：儿童肺栓塞症(PE)导致严重的死亡，有证据表明它被低估了。临床概率评分和D-二聚体估计评估试验前概率尚未在疑似PE的儿童中进行研究。患者/方法：这项回顾性队列研究评估了50例PE患儿和25例PE阴性对照儿童的Wells简化概率评分，以及27例PE阳性和12例PE阴性儿童的D-二聚体水平。结果：PE阳性组与PE阴性组发生静脉血栓栓塞症(VTE)的危险因素发生率相似。Wells简化概率评分显示，PE阳性儿童与PE阴性儿童之间差异不大(中位数：PE阳性4分；PE阴性4分；P=0.009)，PE儿童更有可能获得PE可能性得分(4分)，P=0.012。在调整Wells评分以考虑到儿童正常范围的心率(P=0.007)和上肢深静脉血栓的体征/症状(P=0.006)后，差异有更大的意义。PE患儿和PE阴性患儿的D-二聚体水平均在正常范围内(PE阳性15%，PE阴性25%，P=0.654)。在1/12(8%)的体育阴性儿童中，有1/12(8%)的儿童出现了不太可能的体育评分和正常的D-二聚体。结论：Wells临床概率评分和D-二聚体估计在确定儿童PE的前测概率方面可能缺乏实用价值。由于少见的儿童期PE，通过前瞻性研究，结合D-二聚体估计的儿科临床概率评分的验证将是困难的。
Background: Childhood pulmonary embolism (PE) causes significant mortality and evidence suggests that it is under-diagnosed. Clinical probability scores and D-dimer estimation to assess pre-test probability have not been studied in children with suspected PE. Patients/Methods: This retrospective cohort study evaluated Wells simplified probability score for PE in 50 children with PE and 25 PE negative control patients, and D-dimer values in 27 PE positive and 12 PE negative children. Results: PE positive and PE negative groups had similar rates of risk factors for venous thromboembolism (VTE). Wells simplified probability score showed a small difference between PE positive and PE negative children (median score: PE positive, 4.5; PE negative, 4; P = 0.009), children with PE are more likely to obtain a 'PE likely' score (score > 4), P = 0.012. The difference was of slightly greater significance when the Wells score was adjusted to account for pediatric normal ranges for heart rate, P = 0.007, and signs/symptoms of upper limb DVT, P = 0.006. Children with PE were as likely as PE negative patients to have a D-dimer value within the normal range (PE positive, 15%; PE negative, 25%; P = 0.654). A combination of a 'PE unlikely' score and normal D-dimer value occurred in 1/12 (8%) of PE negative children. Conclusions: The Wells clinical probability score and D-dimer estimation may lack utility in the determination of pre-test probability of PE in children. Validation of a pediatric clinical probability score, incorporating D-dimer estimation, by prospective study, would be difficult as a result of the rarity of childhood PE.