Search

Your search keyword '"Centre de Recherche Clinique (CRC Angers)"' showing total 16 results
Start Over Author "Centre de Recherche Clinique (CRC Angers)"
16 results on '"Centre de Recherche Clinique (CRC Angers)"'

1. Allogeneic stem cell transplantation recipients requiring intensive care: time is of the essence

Author

Aline Tanguy-Schmidt, Sylvie François, Sylvain Thepot, Corentin Orvain, Mathilde Hunault-Berger, Pierre Asfar, Mélanie Mercier, Norbert Ifrah, Jean-François Hamel, François Beloncle, Jonathan Farhi, Aurélien Sutra Del Galy, Alain Mercat, Achille Kouatchet, Innate Immunity and Immunotherapy (CRCINA-ÉQUIPE 7), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), Service des maladies du sang [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Fédérations hospitalo-universitaires Grand Ouest Acute Leukemia [Angers] (FHU GOAL), Réanimation Médicale [CHU Angers], Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), Bernardo, Elizabeth, Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Innate immunity and Immunotherapy ( CRCINA - Département INCIT - Equipe 7 ), Centre de recherche de Cancérologie et d'Immunologie / Nantes - Angers ( CRCINA ), Université d'Angers ( UA ) -Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche en Santé de l'Université de Nantes ( IRS-UN ) -Centre hospitalier universitaire de Nantes ( CHU Nantes ) -Université d'Angers ( UA ) -Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche en Santé de l'Université de Nantes ( IRS-UN ) -Centre hospitalier universitaire de Nantes ( CHU Nantes ), CHU Angers, Fédérations hospitalo-universitaires Grand Ouest Acute Leukemia [Angers] ( FHU GOAL ), Centre hospitalier universitaire d'Angers ( CHU Angers ), Centre de Recherche Clinique ( CRC Angers ), and Université d'Angers ( UA ) -CHU Angers

Subjects
Adult, Male, Intensive care unit (ICU), medicine.medical_specialty, Time Factors, Critical Care, Graft vs Host Disease, [SDV.CAN]Life Sciences [q-bio]/Cancer, Early admission, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, law.invention, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Refractory, law, Risk Factors, Intensive care, medicine, Humans, Transplantation, Homologous, Hospital Mortality, Retrospective Studies, business.industry, Mortality rate, Hematopoietic Stem Cell Transplantation, Retrospective cohort study, Hematology, General Medicine, Middle Aged, Intensive care unit, Lymphoproliferative Disorders, 3. Good health, Transplantation, Hospitalization, Intensive Care Units, 030220 oncology & carcinogenesis, Hematologic Neoplasms, Emergency medicine, Allogeneic stem cell transplantation (SCT), Female, Stem cell, business, 030215 immunology
Abstract

International audience; The benefit of early admission of allogeneic stem cell transplantation (SCT) recipients to the intensive care unit (ICU) as soon as they develop organ injury is unknown. We performed a retrospective study on 92 patients admitted to the ICU to determine the impact of time from organ injury to ICU admission on outcome. The number of organ injuries prior to ICU admission was associated with an increased in-hospital mortality (OR 1.7, 95% CI 1–2.7, p = 0.04). Time between first organ injury and ICU admission was also associated with an increased in-hospital survival (OR 1.4, 95% CI 1.1–1.8, p = 0.02). A score combining these two covariates—the number of organ injuries/day (sum of days spent with each individual organ injury)—further improved the prediction of hospital survival. Patients with more organ injuries/day had significantly higher in-hospital mortality rate even after adjustment for refractory acute GVHD and the SOFA (OR 1.3, 95% CI 1–1.7, p = 0.02). Early ICU admission of allogeneic SCT recipients to the ICU as soon as they develop organ injury is associated with decreased in-hospital mortality.

Published
2018

2. Comparison of fondaparinux with low molecular weight heparin for venous thromboembolism prevention in patients requiring rigid or semi-rigid immobilization for isolated non-surgical below-knee injury

Author

Samama, C. M, Lecoules, N, Kierzek, G, Claessens, Y. E, Riou, B, Rosencher, N, Mismetti, P, Sautet, A, Barrellier, M. -T, Apartsin, K, Jonas, M, Caeiro, J. R, van der Veen, A. H, Roy, P. -M, Accetta, R, Adnet, F, Akhmetova, I, Banihachemi, J. -J, Barbarash, O. L, Barrelier, M. -T, Belentsov, S. M, Bella, S, Benítez, P. C, Bouget, J, Brassart, C, Brem, M, Brule, K, Caeiro Rey, J. R, Caeiro, R, Caimi, M, Castelli, C, Causero, A, Cebrián, A. F, Chabe, C, Cherny, S, Chernyatina, M, Coletta, S. D, Compagnon, A, Couy, C, Crespo, E. C, D'Errico, A. -M, Dahmen, G. P, Deschamps, P, Detomatis, C, Direr, M. -A, Dominguez, S. S, Dupont, P, Ershova, O. B, Faensen, B, Ferrari, S, Ferrata, P, Fleur, F, Fontanel, A, Foronda, I. E, Fort, P. -A, Fragneaud, C, Franchin, F, Franco, M. L, Froehlich, H, Galdo Pérez, J. M, Gauss, H, Gerisch, S, Girard, P, Gottwalles, Y, Haouas, T, Huber, X, Huther, P, Ibán, M. R, Joly, L. -M, Joseph, A, Kazakov, Y, Koehler, J, Koroteev, R, Kort, N. P, Kotelnikov, M. V, Kuropatkin, G, Lablanche, C, Lahne, U, Le Gall, C, Leizorovicz, A, Leluherne, Y, Lenskaya, L, Louis, K, Lozano Moreno, F. J, Maier-Bosse, I, Mairal, O. M, Mallem, A, Manoukian, A, Martos, T. A, Martínez, A. D, Masmoudi, R, Massè, A, Merah, A, Meyer, V, Nachbaur, G, Namir, N, Navarrete, F. G, Olmeda, A, Orinel, E, Pateron, D, Peidró, L, Plechev, V. V, Poissonnet, M, Popov, A, Potel, G, Preusche, A, Quentzel, S, Quilliec, C, Rabier, P, Ramos, M. M, Rebezov, K, Renaud, B, Roca Ruiz, L. J, Ruppe, U, Saliceto, A, Schluender, M, Schmidt, J, Schulz, A. P, Serikova, S, Sevestre, M. -A, Shvalb, P. G, Smirnov, G, Sokurenko, G. Y, Solodovnikov, A, Soroka, V. V, Subbotin, Y, Suplotova, L, Sánchez, M. C, Testroote, M. J. G, Tyuyushev, I, Vasiliev, A, Vasselle, M, Verleisdonk, E. J. M. M, Voss, G, Wallet, E, Weimar, H, Weisslinger, N, Wetzig, L, Yuzko, T, Zafra Jiménez, J. A, Zgura, V, Zhukov, B. N, Zonova, E, Zubareva, N, Zufferey, P, de Fatima Ouedraogo, M, van Haren-Breure, E, van Olden, G. D. J., Service d'anesthésie-réanimation [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Hôtel-Dieu [Paris], Service des Urgences ( TOULOUSE - Urgences ), CHU Toulouse [Toulouse], Service des Urgences ( HOTEL DIEU - Urgences ), Assistance publique - Hôpitaux de Paris (AP-HP), Département de Médecine d'Urgence ( MONACO - Urgences ), Princess Grace Hospital Center, Service d'Accueil des Urgences [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [APHP]-Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Saint Etienne, Université Jean Monnet [Saint-Étienne] ( UJM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Groupe de recherche sur la thrombose ( GRT (EA 3065) ), Université Jean Monnet [Saint-Étienne] ( UJM ), Service de Chirurgie Orthopédique et Traumatologie [CHU Saint-Antoine], CHU Saint-Antoine [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP), Service d'Explorations Fonctionnelles, Hôpital côte de nacre, Scientific Center for Reconstructive and Restorative Surgery ( RUSSIE - IRKUTSK - SCRRS ), Academy of Medical Sciences, Sankt-Joseph Hospital ( Sankt-Joseph Hospital ), Sankt-Joseph Hospital, Department of Orthopedic Surgery ( SANTIAGO - Chir Ortho ), Santiago de Compostela University Hospital, Department of Surgery ( EINDHOVEN - Surgery ), Catharina Hospital, Centre de Recherche Clinique ( CRC Angers ), Université d'Angers ( UA ) -CHU Angers, Service des Urgences ( PMR ), CHRU - ANGERS, Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service des Urgences (TOULOUSE - Urgences), Service des Urgences (HOTEL DIEU - Urgences), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de Médecine d'Urgence (MONACO - Urgences), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service des Explorations Fonctionnelles [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Scientific Center for Reconstructive and Restorative Surgery (RUSSIE - IRKUTSK - SCRRS), Sankt-Joseph Hospital (Sankt-Joseph Hospital), Department of Orthopedic Surgery (SANTIAGO - Chir Ortho), Department of Surgery (EINDHOVEN - Surgery), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), and Service des Urgences (PMR)

Subjects
Adult, Male, medicine.medical_specialty, medicine.drug_class, Deep vein, [SDV]Life Sciences [q-bio], Low molecular weight heparin, 030204 cardiovascular system & hematology, Fondaparinux, Asymptomatic, 03 medical and health sciences, Immobilization, 0302 clinical medicine, Polysaccharides, medicine, Humans, 030212 general & internal medicine, [ SDV ] Life Sciences [q-bio], Heparin, business.industry, low molecular weight heparin, Low-Molecular-Weight, Anticoagulants, Hematology, Venous Thromboembolism, Bleed, Heparin, Low-Molecular-Weight, bleeding, medicine.disease, Thrombosis, 3. Good health, Pulmonary embolism, Surgery, fondaparinux, lower limb, prophylaxis, trauma, venous thromboembolism, Female, Leg Injuries, medicine.anatomical_structure, Nadroparin, medicine.symptom, business, medicine.drug
Abstract

International audience; BACKGROUND: In several small studies, anticoagulant therapy reduced the incidence of venous thromboembolism (VTE) in patients with isolated lower-limb injuries. OBJECTIVES: To compare the efficacy and safety of fondaparinux 2.5 mg (1.5 mg in patients with a creatinine clearance between 30 and 50 mL min(-1) ) over nadroparin 2850 anti-factor Xa IU. PATIENTS AND METHODS: In this international, multicenter, randomized, open-label study, patients with an isolated non-surgical unilateral below-knee injury having at least one additional major risk factor for VTE and requiring, in the Investigator's opinion, rigid or semi-rigid immobilization for 21-45 days with thromboprophylaxis up to complete mobilization received subcutaneously once-daily either fondaparinux or nadroparin. The primary efficacy outcome was the composite of VTE (symptomatic or ultrasonographically detected asymptomatic deep vein thrombosis of the lower limb or symptomatic pulmonary embolism) and death up to complete mobilization. The main safety outcome was major bleeding. RESULTS: We randomized 1349 patients (mean age 46 years): 88.7% had a bone fracture, and 83.8% had a plaster cast fitted (mean duration of immobilization, 34 days). The primary efficacy outcome occurred in 15 of 584 patients (2.6%) in the fondaparinux group and 48 of 586 patients (8.2%) in the nadroparin group (odds ratio, 0.30; 95% confidence interval [CI], 0.15-0.54; P

Published
2013

3. Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): a multicentre, prospective, observational study

Author

Andrea Penaloza, Quentin Delmez, Olivier Sanchez, N. Delvau, Nicolas Marjanovic, Alexandre Ghuysen, Jeannot Schmidt, Thomas Moumneh, Farès Moustafa, Christian Brice, Philippe Girard, Guy Meyer, Grégoire Le Gal, Béatrice Gable, Jacques Bouget, Lionel Imsaad, Caroline Soulie, Pierre-Marie Roy, Catherine Le Gall, A Trinh-Duc, Dominique El Kouri, Jean-Marie Chretien, Service des Urgences [CHU Nantes], Hôtel-Dieu de Nantes, Modélisation Conceptuelle des Connaissances Biomédicales, Université de Rennes (UR), Département des Urgences, CHU Clermont-Ferrand, Service d'Accueil des Urgences (AGEN - SAU), Centre Hospitalier d'Agen, Centre Hospitalier Victor Dupouy, Délégation à la recherche clinique et innovation, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Laboratoire de l'intégration, du matériau au système (IMS), Université Sciences et Technologies - Bordeaux 1 (UB)-Institut Polytechnique de Bordeaux-Centre National de la Recherche Scientifique (CNRS), Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université Sciences et Technologies - Bordeaux 1-Institut Polytechnique de Bordeaux-Centre National de la Recherche Scientifique (CNRS), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)

Subjects
Adult, Pediatrics, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Population, 030204 cardiovascular system & hematology, White People, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, medicine, Clinical endpoint, Humans, Prospective Studies, 030212 general & internal medicine, education, Prospective cohort study, False Negative Reactions, Case report form, ComputingMilieux_MISCELLANEOUS, Aged, Ultrasonography, education.field_of_study, Intention-to-treat analysis, business.industry, Angiography, Anticoagulants, Hematology, Emergency department, Middle Aged, medicine.disease, 3. Good health, Pulmonary embolism, Treatment Outcome, Observational study, Emergency Service, Hospital, Pulmonary Embolism, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Summary Background The ability of the pulmonary embolism rule-out criteria (PERC) to exclude pulmonary embolism without further testing remains debated outside the USA, especially in the population with suspected pulmonary embolism who have a high prevalence of the condition. Our main objective was to prospectively assess the predictive value of negative PERC to rule out pulmonary embolism among European patients with low implicit clinical probability. Methods We did a multicentre, prospective, observational study in 12 emergency departments in France and Belgium. We included consecutive patients aged 18 years or older with suspected pulmonary embolism. Patients were excluded if they had already been hospitalised for more than 2 days, had curative anticoagulant therapy in progress for more than 48 h, or had a diagnosis of thromboembolic disease documented before admission to emergency department. Physicians completed a standardised case report form comprising implicit clinical probability assessment (low, moderate, or high) and a list of risk factors including criteria of the PERC rule. They were asked to follow international recommendations for diagnostic strategy, masked to PERC assessment. The primary endpoint was the proportion of patients with low implicit clinical probability and negative PERC who had venous thromboembolic events, diagnosed during initial diagnostic work-up or during 3-month follow-up, as externally adjudicated by an independent committee masked to the PERC and clinical probability assessment. The upper limit of the 95% CI around the 3-month thromboembolic risk was set at 3%. We did all analyses by intention to treat, including all patients with complete follow-up. This trial is registered with ClinicalTrials.gov, number NCT02360540. Findings Between May 1, 2015, and April 30, 2016, 1773 consecutive patients with suspected pulmonary embolism were prospectively assessed for inclusion, of whom 1757 were included. 1052 (60%) patients were classed as having low clinical probability, 49 (4·7%, 95% CI 3·5–6·1) of whom had a venous thromboembolic event. In patients with a low implicit clinical probability, 337 (32%) patients had negative PERC, of whom four (1·2%; 95% CI 0·4–2·9) went on to have a pulmonary embolism. Interpretation In European patients with low implicit clinical probability, PERC can exclude pulmonary embolism with a low percentage of false-negative results. The results of our prospective, observational study allow and justify an implementation study of the PERC rule in Europe. Funding French Ministry of Health.

Published
2017

4. Different Impact of the Number of Organ Failures and Graft-Versus-Host Disease on the Outcome of Allogeneic Stem Cell Transplantation Recipients Requiring Intensive Care

Author

Philippe Guardiola, Sylvie François, François Beloncle, Sylvain Thepot, Mathilde Hunault-Berger, Achille Kouatchet, Norbert Ifrah, Jean-François Hamel, Jonathan Farhi, Aline Tanguy-Schmidt, Alain Mercat, Mélanie Mercier, Corentin Orvain, Pierre Asfar, Service des maladies du sang [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service de Réanimation Médicale et de Médecine Hyperbare [Angers], Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Plateforme SNP, Transcriptome & Epigénomique, and Bernardo, Elizabeth

Subjects
Male, Time Factors, medicine.medical_treatment, Graft vs Host Disease, Kaplan-Meier Estimate, law.invention, Patient Admission, 0302 clinical medicine, Risk Factors, law, Odds Ratio, Hospital Mortality, Middle Aged, Intensive care unit, Patient Discharge, 3. Good health, Intensive Care Units, Treatment Outcome, 030220 oncology & carcinogenesis, Female, France, Adult, medicine.medical_specialty, Critical Care, Multiple Organ Failure, [SDV.CAN]Life Sciences [q-bio]/Cancer, Risk Assessment, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Intensive care, medicine, Humans, Transplantation, Homologous, Renal replacement therapy, Proportional Hazards Models, Retrospective Studies, Mechanical ventilation, Transplantation, Chi-Square Distribution, business.industry, Retrospective cohort study, Odds ratio, medicine.disease, Surgery, Logistic Models, Graft-versus-host disease, Multivariate Analysis, business, Stem Cell Transplantation, 030215 immunology
Abstract

International audience; Background. Admission of allogeneic stem cell transplantation (SCT) recipients to the intensive care unit (ICU) remains controversial , especially when graft-versus-host disease (GVHD) is present. Methods. We performed a retrospective study to assess prognostic factors of survival in all allogeneic SCT recipients admitted to the ICU between 2002 and 2013 in our center which has flexible admission criteria, especially regarding GVHD. Results. Of 349 patients who underwent allogeneic SCT during the study period, 92 patients (26%) were admitted to the ICU. Intensive care unit and hospital discharge rates were 66% and 46%, respectively , whereas 1 year survival was 24%. Acute GVHD, either grade III to IV (30 patients, 33%) or refractory (12 patients, 13%) had a nonsignificant impact on hospital mortality (odds ratio [OR], 2.1; P = 0.1; OR, 5, P = 0.05, respectively). Fifty percent of patients required invasive mechanical ventilation, 30% required vasopressors, 17% required renal replacement therapy, and 28% had liver impairment (bilirubin >34 μmol/L), each of these parameters defining organ failure. Mortality was closely associated with the number of organ failures as hospital discharge rates were 69%, 50%, 42%, and 0% among patients with 0 (26 patients), 1 (26 patients), 2 (26 patients), and 3 to 4 (14 patients) organ failures, respectively (OR, 2.7; 95% confidence interval, 1.6-4.6; P < 0.001 according to the number of organ failures). Conclusions. Early mortality of allogeneic SCT recipients admitted to the ICU is especially influenced by the number of organ failures and therefore patients with 0 to 2 organ failures should be considered if required. Refractory GVHD affects survival but not within the confined ICU admission.

Published
2017

5. Multi-System Adaptation to Confinement During the 180-Day Controlled Ecological Life Support System (CELSS) Experiment

Author

Ming Yuan, Marc-Antoine Custaud, Zi Xu, Jingyu Wang, Min Yuan, Carole Tafforin, Loïc Treffel, Philippe Arbeille, Michel Nicolas, Claude Gharib, Guillemette Gauquelin-Koch, Laurent Arnaud, Jean-Christophe Lloret, Yinghui Li, Nastassia Navasiolava, China Astronaut Research and Training Center [Beijing], Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Laboratoire de psychologie : dynamiques relationnelles et processus identitaires [Dijon] (PSY-DREPI), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Institut NeuroMyoGène (INMG), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National d’Études Spatiales [Paris] (CNES), and Santé

Subjects
ethological monitoring, Physiology, [SHS.PSY]Humanities and Social Sciences/Psychology, Vasodilation, adaptation, lcsh:Physiology, law.invention, 03 medical and health sciences, Muscle tone, 0302 clinical medicine, Deconditioning, law, Physiology (medical), Mars mission, medicine, Controlled ecological life support system, Chronic stress, intima-media thickness, 030304 developmental biology, Original Research, CELSS, chronic stress, 0303 health sciences, lcsh:QP1-981, business.industry, Fluid compartments, spaceflight analog, medicine.anatomical_structure, muscle tone, Lean body mass, Anxiety, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

IF2019: 3.22 (Q1); International audience; Confinement experiments are essential to prepare long-term space exploration. The 180-day Chinese CELSS (Controlled Ecological Life Support System) study is unique in its design, including a closed-loop system and mid-mission simulation of Mars-like day-night cycle of 24 h 40 min for 36 days (days 72-108). Our aim was to study physiological and psychological consequences of this confinement in four healthy volunteers (one female). CELSS platform consisted of six interconnected modules including four greenhouses. Life support systems were controlled automatically. Body composition, fluid compartments, metabolic state, heart, large vessels, endothelial function, and muscle tone were studied using biological, functional, and/or morphological measurements. Behavioral activities were studied by ethological monitoring; psychological state was assessed by questionnaires. Body weight decreased by ∼2 kg mostly due to lean mass loss. Plasma volume and volume-regulating hormones were mostly stable. Carotid intima-media thickness (IMT) increased by 10-15%. Endothelium-dependent vasodilation decreased. Masseter tone increased by 6-14% suggesting stress, whereas paravertebral muscle tone diminished by 10 ± 6%. Behavioral flow reflecting global activity decreased 1.5- to 2-fold after the first month. Psychological questionnaires revealed decrease in hostility and negative emotions but increase in emotional adaptation suggesting boredom and monotony. One subject was clearly different with lower fitness, higher levels of stress and anxiety, and somatic signs as back pain, peak in masseter tone, increased blood cortisol and C-reactive protein. Comparison of CELSS experiment with Mars500 confinement program suggests the need for countermeasures to prevent increased IMT and endothelial deconditioning. Daily activity in greenhouse could act as countermeasure against psycho-physiological deconditioning.

Published
2019

6. Additional testing following screening strategies for occult malignancy diagnosis in patients with unprovoked venous thromboembolism

Author

Emmanuelle Le Moigne, Jean Pastre, Nathalie Prevot-Bitot, Francis Couturaud, Pierre-Yves Le Roux, Philippe Robin, Benjamin Planquette, Pierre-Marie Roy, Pierre-Yves Salaun, Grégoire Le Gal, Adel Merah, Calvez, Ghislaine, CHRU Brest - Service de médecine nucléaire (CHU - BREST - Med Nucléaire), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier de Versailles André Mignot (CHV), Service de Médecine Nucléaire [Saint-Etienne], CHU Saint-Etienne-Hôpital Bellevue, Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), CIC Brest, and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche

Subjects
Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Statistical difference, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, law.invention, [SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, law, Fluorodeoxyglucose F18, Cancer screening, Occult malignancy, medicine, Humans, In patient, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Early Detection of Cancer, Aged, [SDV.IB] Life Sciences [q-bio]/Bioengineering, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, medicine.diagnostic_test, business.industry, Absolute risk reduction, Hematology, Venous Thromboembolism, Middle Aged, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV] Life Sciences [q-bio], Positron emission tomography, Positron-Emission Tomography, Neoplasms, Unknown Primary, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Female, Radiology, business, Nuclear medicine, Tomography, X-Ray Computed, Venous thromboembolism, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

18F-Fluorodesoxyglucose Positron-Emission-Tomography combined with Computed-Tomography (FDG PET/CT) might be an attractive tool for cancer screening in patients with venous thromboembolism (VTE), allowing non-invasive whole-body imaging. One of the frequent criticisms to the use of FDG PET/CT for screening is the potential for false positive results leading to unnecessary/invasive investigations. Our aim was to compare the frequency and invasiveness of additional testing following extensive and limited screening strategies for occult malignancy in patients with unprovoked VTE. We analysed patients included in the MVTEP study, a randomized trial that compared a screening strategy based on FDG-PET/CT with a limited screening strategy for occult malignancy diagnosis in patients with unprovoked VTE. All additional diagnostic procedures following screening were recorded and classified as invasive or non-invasive. A total of 394 patients were analysed. Additional diagnostic procedures realized in patients of each group consisted of 59 tests in patients of the FDG PET/CT group versus 53 tests among the patients from the limited screening group (p=0.65). Overall, 45 (22.8%) patients in the FDG PET/CT group underwent additional diagnostic tests, versus 32 (16.2%) in the limited screening group (absolute risk difference+6.6%, 95% CI -1.3 to +14.4%, p=0.13). Sixteen (8.1%) patients in the FDG PET/CT group underwent invasive procedures, versus 6 (3%) in the limited screening group (absolute risk difference+5.1%, 95% CI +0.5 to +10.0%, p=0.03). We found no statistical difference in the number of additional procedures following each screening strategy. However, a higher number of invasive tests were performed in the FDG PET/CT group.

Published
2017

7. Craniomandibular System and Postural Balance after 3-Day Dry Immersion

Author

Guillemette Gauquelin-Koch, Loïc Treffel, Catherine Millet, Claude Gharib, Marc-Antoine Custaud, Stéphane Blanc, Liubov Dmitrieva, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Département Ecologie, Physiologie et Ethologie (DEPE-IPHC), Institut Pluridisciplinaire Hubert Curien (IPHC), Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Institute of biomedical problems, Russian Academy of Sciences [Moscow] (RAS), Biologie Neurovasculaire et Mitochondriale Intégrée (BNMI), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université d'Angers (UA), Centre National d'Études Spatiales [Toulouse] (CNES), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre International d'Ostéopathie, Service d'Odontologie Hospices Civils de Lyon, CNES Number 2015 48 0000079, Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Gaillard, Brigitte

Subjects
Male, [SDE] Environmental Sciences, Teeth, Physiology, Dentistry, lcsh:Medicine, Electromyography, Mandible, Masseter muscle, Eating, 0302 clinical medicine, Center of pressure (terrestrial locomotion), Immersion, Postural Balance, Medicine and Health Sciences, Relaxation Time, Artificial Gravity, Medicine, lcsh:Science, Multidisciplinary, medicine.diagnostic_test, Weightlessness, Physics, Muscle Analysis, Bioassays and Physiological Analysis, Muscle Tonus, Physical Sciences, [SDE]Environmental Sciences, Anatomy, Muscle Contraction, Research Article, Gravitation, Adult, Cognitive Neuroscience, Research and Analysis Methods, Bite Force, 03 medical and health sciences, Motor Reactions, stomatognathic system, Ocular System, Immersion (virtual reality), Humans, Relaxation (Physics), Weightlessness Simulation, business.industry, Masseter Muscle, lcsh:R, Biology and Life Sciences, 030206 dentistry, Bite force quotient, Postural Control, Jaw, Tonicity, Cognitive Science, Eyes, lcsh:Q, business, Physiological Processes, Head, Digestive System, 030217 neurology & neurosurgery, Neuroscience
Abstract

International audience; The objective of the study was to determine the influence of simulated microgravity by exposure to dry immersion on the craniomandibular system. Twelve healthy male volunteers participated in a 3-day dry immersion study. Before and immediately after exposure we measured maximal bite force using piezoresistive sensors. The mechanical properties of the jaw and cervical muscles were evaluated before, during, and after dry immersion using MyotonPRO. Because recent studies reported the effects of jaw motor activity on the pos-tural stability of humans, stabilometric measurements of center of pressure were performed before and after dry immersion in two mandibular positions: rest position without jaw clenching , and intercuspidal position during voluntary teeth clenching. Results revealed no significant changes of maximal bite force after dry immersion. All postural parameters were significantly altered by dry immersion. There were however no significant differences in sta-bilometric data according to mandibular position. Moreover the masseter tonicity increased immediately after the end of dry immersion period. Dry immersion could be used as a valid model for studying the effects of microgravity on human subjects. However, 3 days appear insufficient in duration to evaluate the effects of weightlessness on maximal bite force. Our research suggests a link between postural disturbance after dry immersion and masseter tonicity.

Published
2016

8. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial

Author

Dominique Mottier, Guy Meyer, Jacques Cornuz, Michel Nonent, Pierre-Alexandre Alois Poletti, Henri Bounameaux, Olivier Sanchez, Grégoire Le Gal, Marc Philip Righini, Arnaud Perrier, Cédric Petit Le Manach, Frédéric Thys, Thomas V. Perneger, Drahomir Aujesky, Olivier Thierry Rutschmann, Franck Verschuren, Pierre-Marie Roy, Marie-Pierre Revel, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Internal Medicine (DIM -CHUV), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service des Urgences (PMR), CHRU - ANGERS, Emergency Department (FV - ED), Saint Luc University Hospital, Division of General Internal Medicine, Université de Lausanne (UNIL), Département de radiologie [Brest] (DR - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Emergency Radiology Service, HUG (HUG), Université de Genève (UNIGE), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Division of Clinical Epidemiology (DCE), Geneva University Hospital (HUG), Service de médecine interne générale (SMIG), Hôpital Universitaire de Genève = University Hospitals of Geneva (HUG), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Lausanne = University of Lausanne (UNIL), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), and Université de Genève = University of Geneva (UNIGE)

Subjects
Male, MESH: Pulmonary Embolism, Pulmonary Embolism/diagnosis/etiology/ultrasonography, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, Randomized controlled trial, Risk Factors, MESH: Risk Factors, law, 030212 general & internal medicine, Geneva score, Ultrasonography, Venous Thrombosis, MESH: Middle Aged, Respiratory disease, MESH: Enzyme-Linked Immunosorbent Assay, General Medicine, Middle Aged, Thrombosis, 3. Good health, Pulmonary embolism, medicine.anatomical_structure, Female, Venous Thrombosis/complications, Radiology, MESH: Tomography, X-Ray Computed, Fibrin Fibrinogen Degradation Products/metabolism, medicine.medical_specialty, MESH: Probability, Enzyme-Linked Immunosorbent Assay, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, MESH: Fibrin Fibrinogen Degradation Products, medicine, Humans, ddc:610, Vein, Contraindication, Probability, MESH: Humans, business.industry, medicine.disease, MESH: Male, Surgery, Clinical trial, MESH: Venous Thrombosis, Pulmonary Embolism, Tomography, X-Ray Computed, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; BACKGROUND: Multislice CT (MSCT) combined with D-dimer measurement can safely exclude pulmonary embolism in patients with a low or intermediate clinical probability of this disease. We compared this combination with a strategy in which both a negative venous ultrasonography of the leg and MSCT were needed to exclude pulmonary embolism. METHODS: We included 1819 consecutive outpatients with clinically suspected pulmonary embolism in a multicentre non-inferiority randomised controlled trial comparing two strategies: clinical probability assessment and either D-dimer measurement and MSCT (DD-CT strategy [n=903]) or D-dimer measurement, venous compression ultrasonography of the leg, and MSCT (DD-US-CT strategy [n=916]). Randomisation was by computer-generated blocks with stratification according to centre. Patients with a high clinical probability according to the revised Geneva score and a negative work-up for pulmonary embolism were further investigated in both groups. The primary outcome was the 3-month thromboembolic risk in patients who were left untreated on the basis of the exclusion of pulmonary embolism by diagnostic strategy. Clinicians assessing outcome were blinded to group assignment. Analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00117169. FINDINGS: The prevalence of pulmonary embolism was 20.6% in both groups (189 cases in DD-US-CT group and 186 in DD-CT group). We analysed 855 patients in the DD-US-CT group and 838 in the DD-CT group per protocol. The 3-month thromboembolic risk was 0.3% (95% CI 0.1-1.1) in the DD-US-CT group and 0.3% (0.1-1.2) in the DD-CT group (difference 0.0% [-0.9 to 0.8]). In the DD-US-CT group, ultrasonography showed a deep-venous thrombosis in 53 (9% [7-12]) of 574 patients, and thus MSCT was not undertaken. INTERPRETATION: The strategy combining D-dimer and MSCT is as safe as the strategy using D-dimer followed by venous compression ultrasonography of the leg and MSCT for exclusion of pulmonary embolism. An ultrasound could be of use in patients with a contraindication to CT.

Published
2008

9. The Simplified Pulmonary Embolism Severity Index (PESI): validation of a clinical prognostic model for pulmonary embolism

Author

Marc Philip Righini, G. Le Gal, Drahomir Aujesky, Guy Meyer, P.-M. Roy, F. Verschuren, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Department of Emergency Medicine, Saint Luc University Hospital, Division of General Internal Medicine, Université de Lausanne (UNIL), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
MESH: Pulmonary Embolism, medicine.medical_specialty, Validation study, Index (economics), MEDLINE, 030204 cardiovascular system & hematology, Severity of Illness Index, MESH: Prognosis, 03 medical and health sciences, 0302 clinical medicine, Pulmonary Embolism/pathology, MESH: Severity of Illness Index, Severity of illness, medicine, Humans, 030212 general & internal medicine, MESH: Models, Theoretical, ComputingMilieux_MISCELLANEOUS, ddc:616, MESH: Humans, business.industry, Hematology, Models, Theoretical, Prognosis, medicine.disease, Pulmonary embolism, Surgery, Emergency medicine, Prognostic model, Pulmonary Embolism, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience

Published
2011

10. Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts

Author

Pieter Willem Kamphuisen, Marieke J. H. A. Kruip, Marc Philip Righini, Pierre-Marie Roy, Grégoire Le Gal, Henri Bounameaux, Renée A. Douma, Maaike Sohne, Harry R. Büller, Arnaud Perrier, Department of Vascular Medicine (DVM - AMC), Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA)-University of Amsterdam [Amsterdam] (UvA), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Division of Internal General Medicine (DIGM), University of Geneva [Switzerland], Department of Haematology (DH - Rotterdam), Erasmus Medical Centre, Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Faculteit der Geneeskunde, Hematology, Cardiovascular Centre (CVC), Vascular Ageing Programme (VAP), Vascular Medicine, and ACS - Amsterdam Cardiovascular Sciences

Subjects
Male, MESH: Pulmonary Embolism, validity, Pediatrics, retrospective study, 030204 cardiovascular system & hematology, 0302 clinical medicine, MESH: Aged, 80 and over, Belgium, Older patients, Medicine, 030212 general & internal medicine, Biological Markers/blood, comparative study, Netherlands, General Environmental Science, ddc:616, Aged, 80 and over, MESH: Aged, receiver operating characteristic, MESH: Middle Aged, article, Age Factors, General Engineering, General Medicine, Middle Aged, Reference Standards, cohort analysis, 3. Good health, Pulmonary embolism, priority journal, D dimer, Female, MESH: Reference Standards, diagnostic value, France, lung embolism, Switzerland, Cohort study, Adult, medicine.medical_specialty, Age adjustment, Pulmonary Embolism/*diagnosis, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, D-dimer, MESH: Fibrin Fibrinogen Degradation Products, false negative result, Humans, controlled study, Fibrin Fibrinogen Degradation Products/*analysis, human, Derivation, Aged, Retrospective Studies, MESH: Age Factors, MESH: Humans, Receiver operating characteristic, business.industry, MESH: Biological Markers, Retrospective cohort study, MESH: Adult, MESH: Retrospective Studies, MESH: ROC Curve, medicine.disease, major clinical study, MESH: Male, ROC Curve, General Earth and Planetary Sciences, Pulmonary Embolism, business, MESH: Female, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Objectives In older patients, the the D-dimer test for pulmonary embolism has reduced specificity and is therefore less useful. In this study a new, age dependent cut-off value for the test was devised and its usefulness with older patients assessed. Design Retrospective multicentre cohort study. Setting General and teaching hospitals in Belgium, France, the Netherlands, and Switzerland. Patients 5132 consecutive patients with clinically suspected pulmonary embolism. Intervention Development of a new D-dimer cut-off point in patients aged >50 years in a derivation set (data from two multicentre cohort studies), based on receiver operating characteristics (ROC) curves. This cut-off value was then validated with two independent validation datasets. Main outcome measures The proportion of patients in the validation cohorts with a negative D-dimer test, the proportion in whom pulmonary embolism could be excluded, and the false negative rates. Results The new D-dimer cut-off value was defined as (patient's age x 10) mu g/l in patients aged >50. In 1331 patients in the derivation set with an "unlikely" score from clinical probability assessment, pulmonary embolism could be excluded in 42% with the new cut-off value versus 36% with the old cut-off value (70 years, ranging from 13% to 16% in the three datasets. The failure rates (all ages) were 0.2% (95% CI 0% to 1.0%) in the derivation set and 0.6% (0.3% to 1.3%) and 0.3% (0.1% to 1.1%) in the two validation sets. Conclusions The age adjusted D-dimer cut-off point, combined with clinical probability, greatly increased the proportion of older patients in whom pulmonary embolism could be safely excluded.

Published
2010

11. Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism

Author

Pierre-Marie Roy, Grégoire Le Gal, Drahomir Aujesky, Michael J. Fine, Jacques Donzé, Arnaud Perrier, Olivier Sanchez, Franck Verschuren, Marc Philip Righini, Jacques Cornuz, Guy Meyer, Calvez, Ghislaine, Department of Internal Medicine (DIM -CHUV), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Emergency Department (FV - ED), Saint Luc University Hospital, Service de médecine interne générale (SMIG), Hôpital Universitaire de Genève, and Service d'angiologie et d'hémostase (MR)

Subjects
MESH: Pulmonary Embolism, Male, Time Factors, MESH: Hospitalization, MESH: Risk Assessment, Severity of Illness Index, MESH: Aged, 80 and over, MESH: Risk Factors, Risk Factors, Ambulatory Care, Medicine, Prospective Studies, ddc:616, MESH: Aged, Aged, 80 and over, MESH: Middle Aged, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Hematology, Middle Aged, Prognosis, MESH: Predictive Value of Tests, Pulmonary embolism, MESH: Reproducibility of Results, Europe, Hospitalization, Female, Prognostic variable, medicine.medical_specialty, MESH: Ambulatory Care, Risk Assessment, Sensitivity and Specificity, MESH: Prognosis, Europe/epidemiology, Discriminatory power, Ambulatory care, Predictive Value of Tests, MESH: Severity of Illness Index, Internal medicine, Humans, In patient, Aged, MESH: Humans, Receiver operating characteristic, business.industry, MESH: Time Factors, Pulmonary Embolism/*diagnosis/etiology/mortality/therapy, Reproducibility of Results, MESH: ROC Curve, medicine.disease, MESH: Prospective Studies, MESH: Sensitivity and Specificity, MESH: Male, Confidence interval, Surgery, ROC Curve, Prognostic model, MESH: Europe, business, Pulmonary Embolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

SummaryPractice guidelines recommend outpatient care for selected patients with non-massive pulmonary embolism (PE), but fail to specify how these low-risk patients should be identified. Using data from U.S. patients, we previously derived the Pulmonary Embolism Severity Index (PESI), a prediction rule that risk stratifies patients with PE. We sought to validate the PESI in a European patient cohort. We prospectively validated the PESI in patients with PE diagnosed at six emergency departments in three European countries. We used baseline data for the rule’s 11 prognostic variables to stratify patients into five risk classes (I-V) of increasing probability of mortality. The outcome was overall mortality at 90 days after presentation.To assess the accuracy of the PESI to predict mortality, we estimated the sensitivity, specificity, and predictive values for low- (risk classes I/II) versus higher- risk patients (risk classes III-V), and the discriminatory power using the area under the receiver operating characteristic (ROC) curve. Among 357 patients with PE, overall mortality was 5.9%, ranging from 0% in class I to 17.9% in class V. The 186 (52%) low-risk patients had an overall mortality of 1.1% (95% confidence interval [CI]: 0.1–3.8%) compared to 11.1% (95% CI: 6.8–16.8%) in the 171 (48%) higher- risk patients. The PESI had a high sensitivity (91%,95% CI: 71–97%) and a negative predictive value (99%, 95% CI: 96–100%) for predicting mortality. The area under the ROC curve was 0.78 (95% CI:0.70–0.86). The PESI reliably identifies patients with PE who are at low risk of death and who are potential candidates for outpatient care. The PESI may help physicians make more rational decisions about hospitalization for patients with PE.

Published
2008

12. A positive compression ultrasonography of the lower limb veins is highly predictive of pulmonary embolism on computed tomography in suspected patients

Author

Pierre-Marie Roy, Marc Philip Righini, Grégoire Le Gal, Mohamed Baba-Ahmed, Oliver Lope Sanchez, Henri Bounameaux, Arnaud Perrier, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), and Service de médecine interne générale (SMIG)

Subjects
MESH: Pulmonary Embolism, Male, MESH: Lower Extremity, 030204 cardiovascular system & hematology, Pulmonary vein, MESH: Aged, 80 and over, 0302 clinical medicine, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Ultrasonography, MESH: Aged, Aged, 80 and over, Venous Thrombosis, MESH: Middle Aged, Respiratory disease, Hematology, Middle Aged, MESH: Predictive Value of Tests, 3. Good health, Pulmonary embolism, Lower Extremity, Predictive value of tests, Female, Radiology, medicine.symptom, Adult, medicine.medical_specialty, Adolescent, Medical Records Systems, Computerized, MESH: Medical Records Systems, Computerized, Asymptomatic, Veins, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Predictive Value of Tests, MESH: Fibrin Fibrinogen Degradation Products, medicine, Humans, Aged, MESH: Adolescent, MESH: Humans, MESH: Veins, Vascular disease, business.industry, MESH: Adult, medicine.disease, MESH: Prospective Studies, MESH: Male, Confidence interval, MESH: Venous Thrombosis, MESH: Tomography, Spiral Computed, business, Pulmonary Embolism, MESH: Female, Tomography, Spiral Computed, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

SummaryThe presence of a clot – even asymptomatic – in the proximal lower limb veins of a patient with clinically suspected pulmonary embolism (PE) provides evidence for venous thromboembolism and indicates anticoagulant therapy in such patients. We aimed at assessing the diagnostic performance of compression ultrasonography as compared to multi-slice computed tomography (MSCT) for the diagnosis of PE. We analyzed data from a large outcome management study that included consecutive outpatients referred to the emergency ward with clinically suspected PE. All high clinical probability patients, and all non-high clinical probability patients with a positive D-dimer test underwent both MSCT and CUS. Of the 756 included patients, 232 had PE ruled out on the basis of a negative D-dimer test, and 524 patients underwent both MSCT and CUS. PE was found in 187 out of the 511 patients witha conclusive MSCT. The sensitivity of CUS for the presence of PE on MSCT was 39% (95% confidence interval: 32 to 46%), and its specificity was 99% (95% CI:97 to 100%). Positive and negative likelihood ratios were 42.2 (95% CI: 13.5 to 131.9) and 0.6 (95% CI: 0.5 to 0.7), respectively. We conclude from that large study of unselected patients that CUS has high specificity but low sensitivity, for the diagnosis of PE at MSCT in suspected patients. It allows ruling in the diagnosis of PE without further invasive and/or expensive testing in suspected patients.

Published
2006

13. Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism

Author

Pierre-Marie Roy, Marc Philip Righini, Oliver Lope Sanchez, Arnaud Perrier, Drahomir Aujesky, Henri Bounameaux, Grégoire Le Gal, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Department of Internal Medicine (DIM -CHUV), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), and Service de médecine interne générale (SMIG)

Subjects
Male, MESH: Pulmonary Embolism, 030204 cardiovascular system & hematology, Severity of Illness Index, Cohort Studies, 0302 clinical medicine, 030212 general & internal medicine, MESH: Cohort Studies, First episode, MESH: Aged, MESH: Middle Aged, Anticoagulant drug, MESH: Follow-Up Studies, Middle Aged, MESH: Predictive Value of Tests, 3. Good health, Pulmonary embolism, Venous thrombosis, MESH: Emergency Service, Hospital, MESH: Thromboembolism, Predictive value of tests, Female, Disease Susceptibility, Emergency Service, Hospital, Adult, medicine.medical_specialty, MESH: Probability, MESH: Disease Susceptibility, MESH: Anticoagulants, Sensitivity and Specificity, Diagnosis, Differential, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Predictive Value of Tests, MESH: Diagnosis, Differential, Thromboembolism, Internal medicine, MESH: Severity of Illness Index, Severity of illness, D-dimer, Internal Medicine, medicine, MESH: Fibrin Fibrinogen Degradation Products, Humans, cardiovascular diseases, Aged, Probability, MESH: Humans, business.industry, MESH: Biological Markers, Anticoagulants, MESH: Adult, Emergency department, medicine.disease, MESH: Male, MESH: Sensitivity and Specificity, Surgery, Pulmonary Embolism, business, MESH: Female, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract

International audience; BACKGROUND: D-dimer levels remain elevated in many patients after completion of a 6-month anticoagulant drug course for a first episode of venous thromboembolism (VTE), which may limit the clinical usefulness of D-dimer testing for ruling out a possible recurrence. METHODS: We assessed the safety and usefulness of D-dimer testing in patients with suspected pulmonary embolism (PE) who had experienced a previous VTE. We analyzed data from 2 outcome studies that enrolled 1721 consecutive emergency department patients with clinically suspected PE. Information on the existence of a previous episode of VTE was abstracted from the database. All the patients underwent a sequential diagnostic workup, including an enzyme-linked immunosorbent assay D-dimer test and a 3-month follow-up. RESULTS: The proportion of confirmed PE was 24.1% (415/1719); PE was ruled out by a negative D-dimer test result in 32.7% (462/1411) of the patients without previous VTE but in only 15.9% (49/308) of the patients with previous VTE (P

Published
2006

14. Clinical usefulness of D-dimer testing in cancer patients with suspected pulmonary embolism

Author

Sylvain De Lucia, Marc Philip Righini, Pierre-Marie Roy, Drahomir Aujesky, Grégoire Le Gal, Arnaud Perrier, Guy Meyer, Henri Bounameaux, Calvez, Ghislaine, Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Department of Internal Medicine (DIM -CHUV), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), and Service de médecine interne générale (SMIG)

Subjects
Male, MESH: Pulmonary Embolism, 030204 cardiovascular system & hematology, 0302 clinical medicine, Neoplasms, MESH: Neoplasms, 030212 general & internal medicine, MESH: Aged, MESH: Middle Aged, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Respiratory disease, MESH: Enzyme-Linked Immunosorbent Assay, Hematology, Middle Aged, Reference Standards, MESH: Predictive Value of Tests, 3. Good health, Pulmonary embolism, MESH: Reproducibility of Results, Predictive value of tests, Female, MESH: Reference Standards, medicine.medical_specialty, Enzyme-Linked Immunosorbent Assay, Malignancy, Sensitivity and Specificity, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, D-dimer, MESH: Fibrin Fibrinogen Degradation Products, medicine, Humans, Aged, Models, Statistical, MESH: Humans, business.industry, Vascular disease, Reproducibility of Results, Cancer, Emergency department, medicine.disease, MESH: Sensitivity and Specificity, MESH: Male, Surgery, Pulmonary Embolism, business, MESH: Female, MESH: Models, Statistical, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

SummaryLimited data are available about the diagnostic value of D-dimer testing in cancer patients with clinically suspected pulmonary embolism (PE).Therefore, we evaluated i) the safety and clinical usefulness of an ELISA D-dimer test to rule out PE in cancer patients compared with non-cancer patients and ii) whether adopting a higher D-dimer cut-off value might increase the usefulness of D-dimer in cancer patients. We analysed data from two outcome studies which enrolled 1,721 consecutive patients presenting in the emergency department with clinically suspected PE. Presence of an active malignancy was abstracted from the database. All patients underwent a sequential diagnostic work-up including an ELISA D-dimer test and a 3-month followup. Sensitivity and predictive value (NPV) were 100% in both cancer and non-cancer patients. PE was ruled out by a negative D-dimer test in 494/1,554 (32%) patients without cancer, and in 18/164 (11%) patients witha malignancy. At cut-off values varying from 500 to 900 µg/l, the sensitivity was unchanged (100%, 95% CI: 93% to 100%) and the specificity increased from 16% (95% CI:11% to 24%) to 30% (95% CI:22% to 39%).The 3-month thromboembolic risk was 0% (95 % CI: 0% to 18%) in cancer patients witha negative D-dimer test. ELISA D-dimer appears safe to rule out pulmonary embolism in cancer patients but it is negative in only one of ten patients at the usual cut-off value. Increasing the cut-off value of D-dimer in cancer patients might increase the test’s clinical usefulness.

Published
2006

15. Multidetector-row computed tomography in suspected pulmonary embolism

Author

Grégoire Le Gal, Alain Furber, Guy Meyer, Pierre-Marie Roy, Arnaud Perrier, Nigel Howarth, Anne-Laurence Gourdier, Henri Bounameaux, Alain Davido, Marie-Pierre Revel, Olivier Sanchez, Service de médecine interne générale (SMIG), Hôpital Universitaire de Genève = University Hospitals of Geneva (HUG), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de Radiologie (ALG), Centre Hospitalier Universitaire d'Angers (CHU Angers), Soins Intensifs et Urgences Cardiologiques, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service of Radiodiagnosis and Interventional Radiology (SRIR), Université de Genève = University of Geneva (UNIGE), Emergency Department, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, and University of Geneva [Switzerland]

Subjects
Male, MESH: Pulmonary Embolism, MESH: Femoral Vein, 030204 cardiovascular system & hematology, 0302 clinical medicine, MESH: Aged, 80 and over, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Geneva score, Ultrasonography, Aged, 80 and over, Venous Thrombosis, MESH: Aged, MESH: Middle Aged, Respiratory disease, MESH: Popliteal Vein, General Medicine, MESH: Follow-Up Studies, Middle Aged, MESH: Predictive Value of Tests, 3. Good health, Pulmonary embolism, Venous thrombosis, MESH: Thromboembolism, Predictive value of tests, Female, Radiology, MESH: Tomography, X-Ray Computed, medicine.medical_specialty, Popliteal Vein, MESH: Pulmonary Artery, Pulmonary Artery, MESH: Anticoagulants, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Predictive Value of Tests, Thromboembolism, medicine, MESH: Fibrin Fibrinogen Degradation Products, Humans, Aged, MESH: Humans, business.industry, Vascular disease, Anticoagulants, Femoral Vein, medicine.disease, Confidence interval, MESH: Prospective Studies, MESH: Male, MESH: Venous Thrombosis, business, Pulmonary Embolism, Tomography, X-Ray Computed, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract

International audience; BACKGROUND: Single-detector-row computed tomography (CT) has a low sensitivity for pulmonary embolism and must be combined with venous-compression ultrasonography of the lower limbs. We evaluated whether the use of D-dimer measurement and multidetector-row CT, without lower-limb ultrasonography, might safely rule out pulmonary embolism. METHODS: We included 756 consecutive patients with clinically suspected pulmonary embolism from the emergency departments of three teaching hospitals and managed their cases according to a standardized sequential diagnostic strategy. All patients were followed for three months. RESULTS: Pulmonary embolism was detected in 194 of the 756 patients (26 percent). Among the 82 patients with a high clinical probability of pulmonary embolism, multidetector-row CT showed pulmonary embolism in 78, and 1 patient had proximal deep venous thrombosis and a CT scan that was negative for pulmonary embolism. Of the 674 patients without a high probability of pulmonary embolism, 232 (34 percent) had a negative D-dimer assay and an uneventful follow-up; CT showed pulmonary embolism in 109 patients. CT and ultrasonography were negative in 318 patients, of whom 3 had a definite thromboembolic event and 2 died of possible pulmonary embolism during follow-up (three-month risk of thromboembolism, 1.7 percent; 95 percent confidence interval, 0.7 to 3.9). Two patients had proximal deep venous thrombosis and a negative CT scan (risk, 0.6 percent; 95 percent confidence interval, 0.2 to 2.2). The overall three-month risk of thromboembolism in patients without pulmonary embolism would have been 1.5 percent (95 percent confidence interval, 0.8 to 3.0) if the D-dimer assay and multidetector-row CT had been the only tests used to rule out pulmonary embolism and ultrasonography had not been performed. CONCLUSIONS: Our data indicate the potential clinical use of a diagnostic strategy for ruling out pulmonary embolism on the basis of D-dimer testing and multidetector-row CT without lower-limb ultrasonography. A larger outcome study is needed before this approach can be adopted.

Published
2005

16. Prediction of pulmonary embolism in the emergency department: The revised geneva score

Author

Marc Philip Righini, Grégoire Le Gal, Pierre-Marie Roy, Arnaud Perrier, Drahomir Aujesky, Olivier Sanchez, Henri Bounameaux, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Department of Internal Medicine (DIM -CHUV), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Service de médecine interne générale (SMIG), and Calvez, Ghislaine

Subjects
MESH: Pulmonary Embolism, medicine.medical_specialty, MESH: Algorithms, MESH: Logistic Models, 030204 cardiovascular system & hematology, Decision Support Techniques, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, MESH: Risk Factors, Outcome Assessment, Health Care, Internal Medicine, Humans, Medicine, 030212 general & internal medicine, Geneva score, Prospective cohort study, MESH: Outcome Assessment (Health Care), Aged, Retrospective Studies, MESH: Aged, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, MESH: Humans, business.industry, Respiratory disease, MESH: Decision Support Techniques, Retrospective cohort study, MESH: Retrospective Studies, General Medicine, Emergency department, medicine.disease, MESH: Predictive Value of Tests, 3. Good health, Surgery, Pulmonary embolism, Europe, Logistic Models, MESH: Emergency Service, Hospital, Predictive value of tests, Emergency medicine, MESH: Europe, Emergency Service, Hospital, Pulmonary Embolism, business, Venous thromboembolism, Algorithms, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; BACKGROUND: Diagnosis of pulmonary embolism requires clinical probability assessment. Implicit assessment is accurate but is not standardized, and current prediction rules have shortcomings. OBJECTIVE: To construct a simple score based entirely on clinical variables and independent from physicians' implicit judgment. DESIGN: Derivation and external validation of the score in 2 independent management studies on pulmonary embolism diagnosis. SETTING: Emergency departments of 3 university hospitals in Europe. PATIENTS: Consecutive patients admitted for clinically suspected pulmonary embolism. MEASUREMENTS: Collected data included demographic characteristics, risk factors, and clinical signs and symptoms suggestive of venous thromboembolism. The variables statistically significantly associated with pulmonary embolism in univariate analysis were included in a multivariate logistic regression model. Points were assigned according to the regression coefficients. The score was then externally validated in an independent cohort. RESULTS: The score comprised 8 variables (points): age older than 65 years (1 point), previous deep venous thrombosis or pulmonary embolism (3 points), surgery or fracture within 1 month (2 points), active malignant condition (2 points), unilateral lower limb pain (3 points), hemoptysis (2 points), heart rate of 75 to 94 beats/min (3 points) or 95 beats/min or more (5 points), and pain on lower-limb deep venous palpation and unilateral edema (4 points). In the validation set, the prevalence of pulmonary embolism was 8% in the low-probability category (0 to 3 points), 28% in the intermediate-probability category (4 to 10 points), and 74% in the high-probability category (> or =11 points). LIMITATIONS: Interobserver agreement for the score items was not studied. CONCLUSIONS: The proposed score is entirely standardized and is based on clinical variables. It has sustained internal and external validation and should now be tested for clinical usefulness in an outcome study.

Catalog

Books, media, physical & digital resources
See catalog results