Criteria for the safe use of D -dimer testing in emergency department patients with suspected pulmonary embolism: A multicenter us study

Kline, Jeffrey A.; Nelson, R. Darrell; Jackson, Raymond; Courtney, D. Mark

doi:10.1067/mem.2002.121398

Cited by 133 publications

(83 citation statements)

References 29 publications

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“…Two medical students subsequently were employed to assess 117 patients presenting to one of the participating centers, and they demonstrated a high degree of interobserver agreement (weighted , 0.83). 38 The PISA-PED investigators have reanalyzed data from their initial study and included data on a further 350 patients; the latter were assessed and managed as in the first study. 39 Using appropriate statistical techniques, they derived and cross-validated a 15-variable model (TABLE 6).…”

confidence: 99%

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Does This Patient Have Pulmonary Embolism?

Chunilal

Eikelboom²,

Attia³

et al. 2003

JAMA

156

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confidence: 99%

“…38 This model uses 2 screening variables to assess all patients' age and shock index (heart rate divided by systolic blood pressure). Patients younger than 50 years and with a shock index less than 1 are deemed "nonhigh"; the remaining patients are then further assessed using 4 variables.…”

confidence: 99%

Does This Patient Have Pulmonary Embolism?

Chunilal

Eikelboom²,

Attia³

et al. 2003

JAMA

156

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“…4 Similar results have been obtained in other emergency departments. 5 Initial evaluation and testing should be completed within several hours in the emergency department setting. At that point, the decision to proceed with direct chest imaging for PE must ensue.…”

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confidence: 99%

Spiral Computed Tomography for Acute Pulmonary Embolism

2004

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There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. If imaging is deemed necessary from an initial clinical evaluation such as D-dimer testing, options include nuclear medicine scanning, catheter pulmonary angiography, and spiral CT. In many institutions, spiral CT is becoming established as the first-line imaging test in daily clinical practice. With spiral CT, thrombus is directly visualized, and both mediastinal and parenchymal structures are evaluated, which may provide important alternative or additional diagnoses. However, limitations for the accurate diagnosis of small peripheral emboli, with a reported miss rate of up to 30% with single-slice spiral CT so far, have prevented the unanimous embrace of spiral CT as the new standard of reference for imaging pulmonary embolism. The clinical significance of the detection and treatment of isolated peripheral pulmonary emboli is uncertain. Evidence is accumulating that it is safe practice to withhold anticoagulation in patients with suspected pulmonary embolism on the basis of a negative spiral CT study. Remaining concerns about the accuracy of spiral CT for pulmonary embolism detection may be overcome by the introduction of multidetector-row spiral CT. This widely available technology has improved visualization of peripheral pulmonary arteries and detection of small emboli. The most recent generation of multidetector-row spiral CT scanners appears to outperform competing imaging modalities for the accurate detection of central and peripheral pulmonary embolism. In this review, we assess the current role and future potential of CT in the diagnostic algorithm of acute pulmonary embolism.

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“…1,2 To promote appropriate use of resources, several groups have validated clinical prediction rules to guide clinicians to either test further or exclude PE as a potential diagnosis. [3][4][5][6][7][8] However, a survey of emergency clinicians demonstrated that many use implicit, nonvalidated criteria when formulating a pretest probability. 9 The goal of this study was to determine the association of validated (explicit) and nonvalidated (implicit) criteria with the diagnosis of PE.…”

Section: Introductionmentioning

confidence: 99%

Critical predictors of pulmonary embolism

Guttman

Dankoff

2012

CJEM

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Clinical questionDo specific elements of the history and physical examination predict the presence of pulmonary embolism in the emergency department?Article chosen Courtney DM, Kline JA, Kabrhel C, et al. Clinical features from the history and physical examination that predict the presence or absence of pulmonary embolism in symptomatic emergency department patients: results of a prospective, multicenter study. Ann Emerg Med 2010;55:307-15. ObjectiveTo determine whether implicit clinical predictors previously untested predict the presence of pulmonary embolism in the emergency department.

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Criteria for the safe use of D -dimer testing in emergency department patients with suspected pulmonary embolism: A multicenter us study

Cited by 133 publications

References 29 publications

Does This Patient Have Pulmonary Embolism?

Does This Patient Have Pulmonary Embolism?

Spiral Computed Tomography for Acute Pulmonary Embolism

Critical predictors of pulmonary embolism

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