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Multidetector-row computed tomography in suspected pulmonary embolism
- Source :
- New England Journal of Medicine, New England Journal of Medicine, 2005, 352 (17), pp.1760-8. ⟨10.1056/NEJMoa042905⟩, New England Journal of Medicine, Massachusetts Medical Society, 2005, 352 (17), pp.1760-8. ⟨10.1056/NEJMoa042905⟩
- Publication Year :
- 2005
- Publisher :
- HAL CCSD, 2005.
-
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.
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 00284793 and 15334406
- Database :
- OpenAIRE
- Journal :
- New England Journal of Medicine, New England Journal of Medicine, 2005, 352 (17), pp.1760-8. ⟨10.1056/NEJMoa042905⟩, New England Journal of Medicine, Massachusetts Medical Society, 2005, 352 (17), pp.1760-8. ⟨10.1056/NEJMoa042905⟩
- Accession number :
- edsair.doi.dedup.....778ccab1cdee98404cac2ff4808d3a5f