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Clinical decision rules for PE prospectively validated ... or were they? (Promethus study)
www.pulmccm.org

Clinical decision rules for PE prospectively validated ... or were they? (Promethus study)

Jun 15, 2011
Share this post
Clinical decision rules for PE prospectively validated ... or were they? (Promethus study)
www.pulmccm.org

Douma et al compared the Wells score, Geneva score, and the simplified versions of each, combined with D-dimer, on a prospective cohort of 807 patients with suspected PE (~23% of whom were found to have PE). With a negative D-dimer and a low-probability score using any rule, risk of pulmonary embolism was ~0.5%. However, only ~23% of patients fit this category. CT-angiogram was only done in moderate/high risk patients. Three-month follow-up was the gold standard for patients at low-risk by rules/D-dimer.

Notably, 7 "low-risk" patients were scanned in violation of protocol, and one (14%) had a PE -- this lone patient generated the "0.5%" risk. Which begs the question, how many more patients in the low-risk group would have had PEs discovered on CT-angiogram, had they gotten one? Ann Intern Med 2011;154:709-718. FREE FULL TEXT

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Clinical decision rules for PE prospectively validated ... or were they? (Promethus study)
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