Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism

Roy, Pierre‐Marie; Colombet, Isabelle; Durieux, Pierre; Châtellier, Gilles; Sors, H.; Meyer, Guy

doi:10.1136/bmj.331.7511.259

Cited by 255 publications

(190 citation statements)

References 61 publications

(40 reference statements)

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“…In a recent meta-analysis, the reliability of the scores of Wells score and the revised Geneva score was examined and compared by evaluating the prevalence of the PE in any group of the clinical probability and was demonstrated to be similar (20). In the present study, the simplified Geneva score had a strong correlation with the Well's score results.…”

Section: Discussionsupporting

confidence: 51%

Correlation of the Wells and Simplified Revised Geneva Scores with CT Pulmonary Artery Obstruction Index in Pulmonary Embolism

2017

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Background: The pulmonary artery obstruction index (PAOI), which is evaluated by the CT pulmonary angiography, offers an objective method to measure the severity of pulmonary arteries obstruction. Objectives: We decided to investigate the correlation between the PAOI determined by CT pulmonary angiography, as an index to determine the severity of pulmonary embolism (PE), with two clinical models used for predicting the probability of acute PE, namely the Wells criteria and the simplified revised Geneva score. Patients and Methods: Sixty-four consecutive patients with definite diagnosis of acute PE based on CT pulmonary angiography were enrolled. The Wells score as well as simplified revised Geneva score were calculated retrospectively using the medical records. Then, the PAOI was determined by CT pulmonary angiography. By applying the Pearson's correlation coefficient, the relationships were investigated. Results: The Wells score had a weak correlation with the PAOI (r = 0.29; P = 0.01). The simplified revised Geneva score did not have significant correlation with the PAOI (r = 0.1; P = 0.2). Furthermore, patients with active cancer had significantly higher CT indexes than the other patients with PE (P = 0.046). Conclusion: Although the Wells and simplified revised Geneva scores are used widely for assessing clinical probability of PE, these scores may not necessarily correlate with the severity of PE. The Wells score had a weak correlation and may somehow predict the severity of PE. Malignancy is a significant risk factor found to be correlated with more severe PE.

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Section: Discussionsupporting

confidence: 51%

Correlation of the Wells and Simplified Revised Geneva Scores with CT Pulmonary Artery Obstruction Index in Pulmonary Embolism

2017

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“…A recent meta-analysis of diagnostic strategies for PE found CTPA to have a positive likelihood ratio of 24.1, but even using this higher value, patients with a low pretest probability and positive CTPA still have a posttest probability of PE below the traditional treatment threshold. 33 As most patients undergoing evaluation for suspected PE have a low pretest probability, 17 a substantial number of false-positive diagnoses of PE may still occur, even with a more accurate diagnostic test.…”

Section: Discussionmentioning

confidence: 99%

Impact of reliance on CT pulmonary angiography on diagnosis of pulmonary embolism: A Bayesian analysis

Ranji

Shojania

Trowbridge

et al. 2006

Journal of Hospital Medicine

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BACKGROUNDSpiral computed tomographic pulmonary angiography (CTPA) has become the primary test used to investigate suspected pulmonary embolism (PE) at many institutions, despite uncertainty regarding its sensitivity and specificity. Although CTPA‐based diagnostic algorithms focus on minimizing the false‐negative rate, we hypothesized that increasing use of CTPA also might lead to false‐positive diagnoses.OBJECTIVEDetermine the frequency of possible false‐positive diagnoses of PE when CTPA is the primary diagnostic test.DESIGNRetrospective cohort study.SETTINGTwo academic teaching hospitals.PARTICIPANTS322 patients with suspected PE evaluated with CTPA.MEASUREMENTSWe used a validated prediction rule to determine the pretest probability of PE in each patient. We combined these pretest probabilities with published estimates of CTPA test characteristics to generate expected posttest probabilities of PE. We compared these posttest probabilities to actual treatment decisions to determine the rate of false‐positive diagnoses of PE.RESULTSAmong 322 patients investigated for PE, 37 (12%) had high pretest probability, 101 (32%) moderate, and 184 (57%) low. CT scans were interpreted as positive for PE in 57 patients (17.8%). Regardless of the pretest probability of PE, 96.5% of patients with a positive CTPA were treated with anticoagulants. Even under an optimistic assumption of CTPA test characteristics, as many as 25.4% of these patients may have been treated unnecessarily as a result of a false‐positive diagnosis. Most of these patients had a low pretest probability of PE.CONCLUSIONSFailure to utilize Bayesian reasoning when interpreting CTPA may lead to false‐positive diagnoses of pulmonary embolism in a substantial proportion of patients. Journal of Hospital Medicine 2006;1:81–87. © 2006 Society of Hospital Medicine

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“…Table 2 summarises the performance of some diagnostic tests or algorithms to rule in or rule out pulmonary embolism on the basis of a systematic review. 53 …”

Section: Other Diagnostic Imaging Modalities For Suspected Deep Vein mentioning

confidence: 99%

Pulmonary embolism and deep vein thrombosis

2012

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Pulmonary embolism is the third most common cause of death from cardiovascular disease after heart attack and stroke. Sequelae occurring after venous thrombo embolism include chronic thromboembolic pulmonary hypertension and post-thrombotic syndrome. Venous thromboembolism and atherothrombosis share common risk factors and the common pathophysiological characteristics of infl ammation, hypercoagulability, and endothelial injury. Clinical probability assessment helps to identify patients with low clinical probability for whom the diagnosis of venous thromboembolism can be excluded solely with a negative result from a plasma D-dimer test. The diagnosis is usually confi rmed with compression ultrasound showing deep vein thrombosis or with chest CT showing pulmonary embolism. Most patients with venous thromboembolism will respond to anticoagulation, which is the foundation of treatment. Patients with pulmonary embolism should undergo risk stratifi cation to establish whether they will benefi t from the addition of advanced treatment, such as thrombolysis or embolectomy. Several novel oral anticoagulant drugs are in development. These drugs, which could replace vitamin K antagonists and heparins in many patients, are prescribed in fi xed doses and do not need any coagulation monitoring in the laboratory. Although rigorous clinical trials have reported the eff ectiveness and safety of pharmacological prevention with low, fi xed doses of anticoagulant drugs, prophylaxis remains underused in patients admitted to hospital at moderate risk and high risk for venous thromboembolism. In this Seminar, we discuss pulmonary embolism and deep vein thrombosis of the legs.

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Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism

Cited by 255 publications

References 61 publications

Correlation of the Wells and Simplified Revised Geneva Scores with CT Pulmonary Artery Obstruction Index in Pulmonary Embolism

Correlation of the Wells and Simplified Revised Geneva Scores with CT Pulmonary Artery Obstruction Index in Pulmonary Embolism

Impact of reliance on CT pulmonary angiography on diagnosis of pulmonary embolism: A Bayesian analysis

Pulmonary embolism and deep vein thrombosis

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