Pretest probability assesment and D-dimer testing for pulmonary embolism

肺栓塞的预测概率评估和 D-二聚体检测

• 批准号: 7454185
• 负责人: D. MARK COURTNEY
• 金额: $ 12.74万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-01 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7454185
• 关键词: Accident and Emergency department; Affect; American; Blood; Blood Tests; Blood Vessels; Censuses; Chest Pain; Classification; Clinical; Clinical Research; Cohort Studies; Computer Assisted; Computerized Medical Records Systems; Computers; Couples; Data; Data Storage and Retrieval; Derivation procedure; Detection; Development; Diagnosis; Diagnostic tests; Disease; Emergency Medicine; Ensure; Fellowship; Fibrin fragment D; Funding; Goals; Hour; Image; Low Prevalence; Lung; Measures; Medical Informatics; Mentors; Methods; Modeling; Non-linear Models; Numbers; Observational Study; Outcome; Patients; Phase; Population; Prevalence; Probability; Protocols documentation; Pulmonary Embolism; Range; Rate; Research; Research Infrastructure; Research Personnel; Residencies; Resource Allocation; Resources; Risk; Safety; Score; Screening procedure; Series; Shortness of Breath; Specificity; Symptoms; System; Techniques; Test Result; Testing; Time; Training; Training Programs; Trees; Work; base; computerized; experience; follow-up; improved; indexing; novel strategies; oncology; patient oriented; patient safety; programs; prospective

DESCRIPTION (provided by applicant): This proposal describes a 5 year mentored training program in patient oriented clinical research. The PI has completed a residency and research fellowship in Emergency Medicine and is seeking further training to study Bayesian probability, diagnostic test assessment, resource utilization, and classification tree analysis techniques to predict presence or absence of pulmonary embolism (PE). The most common symptoms of PE, chest pain and shortness of breath are included as the chief complaints of an estimated 10 million people in US emergency departments annually. Testing for PE must be done in conjunction with estimation of the pretest probability that the clinician believes to be existent at the time of patient presentation. There are no uniformly used or accepted means of estimating pretest probability. Two methods have been suggested in North American populations, the Wells score and the Charlotte criteria, but these give only ranges of probability estimates and include a series of questions, which must be memorized. They have been uncommonly used outside of their derivation populations. There has also been a recent proliferation of blood based screening tests for PE such as the quantitative D-dimer test. If normal, in low pretest probability patients, these rapid, highly sensitive, low specificity tests alone may be used to reduce the likelihood of PE to below a safe threshold. The ease of ordering a blood test to screen for PE may result in significant changes in overall test utilization, radiological test use, and overall disease diagnosis. This prospective observational study will quantify the effects of a new quantitative D-dimer on these three parameters, as well as test the hypothesis that low risk patients (Wells and Charlotte criteria) with a negative D-dimer have a very low prevalence of PE (<1.0%) as determined by imaging test results, and 3 month follow-up. To improve the safety, accuracy and efficiency of pretest probability assessment and D-dimer testing, a new model identifying low risk patients (goal: <5% pretest probability) will be derived from this data by non-linear modeling and classification tree analysis. Dr. Charles Bennett will be the mentor for this project and is a national leader in hematological and oncology research. He has significant experience in mentoring junior investigators and an emphasis in disease detection and outcome prediction to ensure development of the PI toward that of an independently funded investigator.

描述（由申请人提供）：

项目成果

A novel online didactic curriculum helps improve knowledge acquisition among non-emergency medicine rotating residents.

新颖的在线教学课程有助于提高非急诊医学轮转住院医师的知识获取。

• DOI: 10.1111/j.1553-2712.2010.00951.x
• 发表时间: 2011
• 期刊: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
• 作者: Branzetti,JeremyB;Aldeen,AmerZ;Foster,AndrewW;Courtney,DMark
• 通讯作者: Courtney,DMark

Hospital-reported data on the pneumonia quality measure "Time to First Antibiotic Dose" are not associated with inpatient mortality: results of a nationwide cross-sectional analysis.

医院报告的肺炎质量指标“首次服用抗生素时间”数据与住院患者死亡率无关：全国横断面分析的结果。

• DOI: 10.1111/j.1553-2712.2011.01053.x
• 发表时间: 2011
• 期刊: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
• 作者: Quattromani,Erin;Powell,EmilieS;Khare,RahulK;Cheema,Navneet;Sauser,Kori;Periyanayagam,Usha;Pirotte,MatthewJ;Feinglass,Joe;MarkCourtney,D
• 通讯作者: MarkCourtney,D

D-dimer and exhaled CO2/O2 to detect segmental pulmonary embolism in moderate-risk patients.

• DOI: 10.1164/rccm.201001-0129oc
• 发表时间: 2010-09
• 期刊: American journal of respiratory and critical care medicine
• 影响因子: 24.7
• 作者: J. Kline;M. Hogg;D. Courtney;Chadwick D Miller;A. E. Jones;H. Smithline;N. Klekowski;R. Lanier

Cost-effectiveness of a novel indication of computed tomography of the coronary arteries.

冠状动脉计算机断层扫描新适应症的成本效益。

• DOI: 10.1097/hpc.0b013e318246854c
• 发表时间: 2012
• 期刊: Critical pathways in cardiology
• 作者: Powell,EmilieS;Patterson,BrianW;Venkatesh,ArjunK;Khare,RahulK
• 通讯作者: Khare,RahulK

D-dimer threshold increase with pretest probability unlikely for pulmonary embolism to decrease unnecessary computerized tomographic pulmonary angiography.

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
• 发表时间: 2012-04
• 期刊: Journal of thrombosis and haemostasis : JTH
• 作者: Kline JA;Hogg MM;Courtney DM;Miller CD;Jones AE;Smithline HA
• 通讯作者: Smithline HA