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摘要:
Objective: To evaluate what specific combination of clinical criteria and d-dimer values may yield at least a 10% positive pulmonary embolism (PE) rate in patients undergoing pulmonary CT angiography (CTA). Materials and Methods: Retrospective review of all patients presenting to the Emergency Department with possible PE who underwent pulmonary CTA and had a d-dimer drawn. Wells scores were retrospectively assigned based on data gathered through medical records. Results: During a 29-month period, 1110 patients underwent pulmonary CTA. Of these, 773 also had a d-dimer drawn. These subjects were stratified based on serum d-dimer levels into negative (≤4 μg/ml), nonpositive (0.41 - 1.0 μg/ml), or positive (>1.0 μg/ml) d-dimer categories. The prevalence of positive CTA studies was >10% only in the positive d-dimer group. Subjects were also stratified based on their Wells score into three clinical categories: low (score 2), intermediate (score = 2 - 6), and high risk of pulmonary embolism (score > 6). The prevalence of positive CTA was > 10% only in the group of subjects with high clinical risk. When stratified according to both Wells criteria and d-dimer, only those patients with intermediate or high clinical risk combined with a positive d-dimer (>1.0 μg/ml) had a prevalence of positive pulmonary CTA > 10%. By limiting the use of CTA studies to those patients with positive d-dimer values or high clinical risk, 438 (55.4%) patients could have avoided CTA imaging. Conclusion: Utilizing CTA only in patients suspected of PE with a combination of high clinical risk based on a Wells criteria threshold score > 6 and a serum d-dimer cutoff of 1 μg/ml would increase the prevalence of positive pulmonary CTA studies above 10% and avoid a large number of CTA imaging studies.
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篇名 Avoiding Unnecessary Pulmonary CT Angiography by Using a Combination of Clinical Criteria and D-Dimer Thresholds
来源期刊 放射学期刊(英文) 学科 医学
关键词 PULMONARY CT ANGIOGRAPHY PULMONARY EMBOLISM WELLS SCORES D-DIMER Values
年,卷(期) 2013,(2) 所属期刊栏目
研究方向 页码范围 78-84
页数 7页 分类号 R73
字数 语种
DOI
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研究主题发展历程
节点文献
PULMONARY
CT
ANGIOGRAPHY
PULMONARY
EMBOLISM
WELLS
SCORES
D-DIMER
Values
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研究分支
研究去脉
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期刊影响力
放射学期刊(英文)
季刊
2164-3024
武汉市江夏区汤逊湖北路38号光谷总部空间
出版文献量(篇)
256
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0
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