当前位置： SCI文献检索 > ANNALS OF INTERNAL MEDICINE期刊下所有文献 > Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies. A systematic review.

Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies. A systematic review.

Abstract：

BACKGROUND:Pulmonary embolism is a common clinical disorder that is associated with high morbidity and mortality if untreated. It is important to confirm or rule out the diagnosis in patients with clinical suspicion of the disease. PURPOSE:To evaluate various diagnostic strategies for excluding pulmonary embolism. DATA SOURCES:MEDLINE (1966 to February 2003), EMBASE, and DARE; study investigators; and reference lists. STUDY SELECTION:Prospective clinical outcome studies. DATA EXTRACTION:The researchers recorded the frequency of symptomatic venous thromboembolism over 3 months of follow-up in patients in whom pulmonary embolism had been excluded according to various strategies. Strategies were divided into three categories according to the number of rounds of diagnostic tests needed to exclude pulmonary embolism. DATA SYNTHESIS:25 studies involving more than 7000 patients were included. In all referred patients, two strategies-normal results on pulmonary angiography or lung scintigraphy and normal d -dimer levels combined with low clinical probability-safely excluded pulmonary embolism (failure rates < or = 3%). In the second round of diagnostic tests, in patients who had had a nondiagnostic lung scan, both pulmonary angiography and serial leg testing for venous thrombosis were accurate and safe. When d -dimer testing combined with clinical probability was inconclusive, a normal perfusion lung scan safely excluded pulmonary embolism. Accumulating evidence shows that normal results on spiral computed tomography may also safely exclude the disease. CONCLUSIONS:Many diagnostic strategies to exclude pulmonary embolism have been evaluated in consecutive patients. Interest is likely to increase in a simple, fast strategy, starting with a normal perfusion lung scan or a combination of normal d -dimer levels and low clinical probability. After the initial round of testing, a reliable diagnostic method, such as angiography or lung scintigraphy, is warranted.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Kruip MJ,Leclercq MG,van der Heul C,Prins MH,Büller HR

doi

10.7326/0003-4819-138-12-200306170-00005

subject

Has Abstract

pub_date

2003-06-17 00:00:00

pages

941-51

issue

eissn

0003-4819

issn

1539-3704

pii

200306170-00005

journal_volume

138

pub_type

杂志文章,评审

在线工具

Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies. A systematic review.