Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases
Pomen algoritmov za izračun klinične verjetnosti pljučne embolije pri diagnosticiranju pljučne embolije v specializirani bolnišnici za pljučne bolezni

english

2010

volume 79, issue 10

Chest Pain   Cough   Diagnosis   diagnostika   Dyspnea   Hemoptysis   Predictive Value Of Tests   Pulmonary Embolism   Retrospective Studies   Roc Curve   Severity Of Illness Index   Syncope

Slovensko zdravniško društvo
(Obvezni izvod spletne publikacije)

Purpose of the Study: Clinical prediction models have been developed to assessthe pre-test probability for pulmonary embolism (PE). The Wells model and the revised Geneva score are the two most well studied. Our purpose was tocompare the two prediction models, and indentify the frequent clinical findings of PE in patients admitted to the University Clinic of Pulmonary and Allergic Diseases Golnik. Methods: In 100 random emergency department patientsand hospital inpatients with suspected PE and performed pulmonary CT angiography (CTPA) as the gold standard, a retrospective assessment of the clinical probability of PE by the Wells rule and the revised Geneva score was made. ECG, D-dimer, NT-proBNP, arterial blood gas analysis, chest X-ray, CTPA and 13 other clinical findings were analysed as well. Results: Average age was65 years (SD 14.5), 39 % were male. The overall prevalence of PE was 33 %. The rates of PE in low, moderate, and high PE risk groups as determined according to the Wells model and the revised Geneva score were 3.7, 53,1, 100,and 14.3, 32.1, 83.3 %, respectively. ROC analysis showed that the Wells model was statistically more accurate than the Geneva score with the area under the curve (AUC) in Wells model 0.85 (95 % CI 0.762-0.936) and in Geneva score 0.73 (95 % CI 0.612-0.838). Sudden dyspnea, active malignancy, venous thromboembolism (VTE) history, estrogen therapy, deep vein thrombosis (DVT) signs, ECG changes and lower PaCO2 were significantly more frequent in PE group. All patients with PE had an increased concentration of D-dimer, and no PE were diagnosed in the group of patients with normal D-dimer. CTPA was ordered in 17 % of patients with low pre-test probability of PE according to Wells criteria and normal D-dimer. (Abstract truncated at 2000 characters)

23.06.2011