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Acute pulmonary embolism pretest probability estimation by d-dimer test, our modified, new ECG score and clinical prediction rules.
Simon, András; Ámon, Tamás; Baracsi-Botos, Viktória; Pálfi, Tímea; Szoke, Vince Bertalan; Püspöki, Zsuzsanna; Varga, Zoltán; Kiss, Loretta Zsuzsa; Szénási, Gábor; Járai, Zoltán; Vereckei, András.
Afiliación
  • Simon A; Department of Cardiology, South Buda Central Hospital, Saint Emeric University Teaching Hospital, Budapest, Hungary.
  • Ámon T; Department of Cardiology, South Buda Central Hospital, Saint Emeric University Teaching Hospital, Budapest, Hungary.
  • Baracsi-Botos V; Department of Cardiology, South Buda Central Hospital, Saint Emeric University Teaching Hospital, Budapest, Hungary.
  • Pálfi T; Department of Cardiology, South Buda Central Hospital, Saint Emeric University Teaching Hospital, Budapest, Hungary.
  • Szoke VB; Department of Cardiology, South Buda Central Hospital, Saint Emeric University Teaching Hospital, Budapest, Hungary.
  • Püspöki Z; Hotel Service Department, South Buda Central Hospital, Saint Emeric University Teaching Hospital, Budapest, Hungary.
  • Varga Z; Hotel Service Department, South Buda Central Hospital, Saint Emeric University Teaching Hospital, Budapest, Hungary.
  • Kiss LZ; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
  • Szénási G; Institute of Translational Medicine, Semmelweis University, Budapest, Hungary.
  • Járai Z; Department of Cardiology, South Buda Central Hospital, Saint Emeric University Teaching Hospital, Budapest, Hungary.
  • Vereckei A; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Heliyon ; 10(17): e36326, 2024 Sep 15.
Article en En | MEDLINE | ID: mdl-39281615
ABSTRACT

Objectives:

We investigated whether a sufficiently sensitive D-dimer test could exclude acute pulmonary embolism (acPE) as a stand-alone diagnostic test and compared our previously published, modified ECG score with the Wells and Geneva scores in the estimation of acPE pretest probability.

Methods:

We retrospectively evaluated 345 patients who underwent chest CT angiography (CTA) for the suspicion of acPE. The pretest probability of acPE was assessed in 120 D-dimer negative [DD (-)] and 225 D-dimer positive [DD (+)] patients.

Results:

Chest CTA verified acPE in 57/345 (16.5 %) patients and in 1/120 (0.8 %) DD (-) patient. In DD (-) patients the test accuracy (TA) and specificity (SP) of the ECG score (98 %, 99 %) were better than those of the Wells score (92.5 %, 92.4 %) (p = 0.063 and p < 0.05 respectively) and the Geneva score (76.7 %, 76.5 %) (p < 0.001 for both), the Wells score TA and SP were greater than those of the Geneva score (p < 0.001 for both). In DD (+) patients the SPs, TAs and positive predictive values (PPV) of the ECG score (94 %, 78.6 %, 69 %) and the Wells score (91.8 %, 75.1 %, 48 %) were greater than those of the Geneva score (71.3 %, 64.9 %, 38.2 %) (p < 0.001 for both SP and TA respectively, and p < 0.001 for PPV of the ECG score vs. the Geneva score and p < 0.05 for PPV of the Wells score vs. Geneva score), their sensitivities (SE) (36.4 %, 23.6 %) were less than that of the Geneva score (47.5 %) (p < 0.05 and p < 0.001 respectively). The ECG score's TA in a trend, its SE and PPV were significantly (p < 0.01 and p < 0.001) better than those of the Wells score.

Conclusion:

In contrast to the current guidelines, a stand-alone high sensitivity DD (-) test, without prediction rules, could reliably exclude acPE. Our ECG score slightly outperformed the Wells score, the ECG score and Wells score far outperformed the Geneva score in the estimation of acPE pretest probability. An acPE diagnosis with the ECG score, in addition to the supportive diagnosis with the clinical prediction rules, may further increase the chance of true DD positivity.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Heliyon Año: 2024 Tipo del documento: Article País de afiliación: Hungria Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Heliyon Año: 2024 Tipo del documento: Article País de afiliación: Hungria Pais de publicación: Reino Unido