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clinical decision rules for pulmonary embolism
Elements of medical history & physical exam to designate the pretest probability of pulmonary embolism as 'likely' or 'unlikely' (see HOPPE score)
Laboratory:
- a positive D-dimer test still warrants further investigation (CT vs VQ scan) if positive regardless of pretest probability
Special laboratory:
- ultrasound that identifies suspected DVT may eliminate radiation exposure & cost of CT angiography [3]
- apparently history of fracture without signs or symptoms of DVT is sufficient for suspicion [3]
Notes:
- Well's rule for deep vein thrombosis
- YEARS clinical decision rule
- Geneva score
- Wells score outperforms Geneva scores in ruling out pulmonary embolism in the primary care setting
- HOPPE score
References
- Douma RA et al.
Performance of 4 clinical decision rules in the diagnostic
management of acute pulmonary embolism: A prospective cohort
study.
Ann Intern Med 2011 Jun 7; 154:709
PMID: 21646554
- Journal Watch, Massachusetts Medical Society
(subscription may be required)
http://general-medicine.jwatch.org/articles/JO2011062301.jpg
- Medical Knowledge Self Assessment Program (MKSAP) 16, 18.
American College of Physicians, Philadelphia 2012, 2018.
- Hendriksen JMT et al
Diagnostic prediction models for suspected pulmonary
embolism: systematic review and independent external
validation in primary care.
BMJ 2015;351:h4438
PMID: 26349907
http://www.bmj.com/content/351/bmj.h4438
- Dachs RJ
Predicting pulmonary embolus in primary care.
BMJ 2015;351:h4594
PMID: 26351275
http://www.bmj.com/content/351/bmj.h4594
- Van der Hulle T, Cheung WY, Kooij S, et al
Simplified Diagnostic Management of Suspected Pulmonary
Embolism (the YEARS Study): A Prospective, Multicentre,
Cohort Study.
Lancet 2017;May 23
PMID: 28549662
http://www.acc.org/latest-in-cardiology/journal-scans/2017/06/02/10/46/simplified-diagnostic-management-of-suspected-pulmonary-embolism