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Computed Tomography Angiography in Patients Evaluated for Acute Pulmonary Embolism with Low Serum D-dimer Levels: A Prospective Study.
MedLine Citation:
PMID:  20740096     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Pulmonary computed tomography angiography (CTA) and the Wells criteria both have interobserver variability in the assessment of pulmonary embolism (PE). Quantitative D-dimer assay findings have been shown to have a high negative predictive value in patients with low pretest probability of PE.
OBJECTIVE: Evaluate roles for clinical probability and CTA in Emergency Department (ED) patients suspected of acute PE but having a low serum D-dimer level.
DESIGN: Prospective observational study of ED patients with possible PE who underwent pulmonary CTA and had D-dimer levels </=1.0 mug/mL.
MAIN OUTCOME: Clinical probability of PE determined by ED physicians using standard published criteria; pulmonary CTAs read by initial and study radiologists kept unaware of D-dimer results.
RESULTS: In 16 months, 744 patients underwent pulmonary CTA, with 347 study participants who had a D-dimer level </= 1.0 mug/mL. In one participant, CTA showed a PE that was agreed on by both the initial and study radiologists. In six participants, the initial findings were reported as positive for PE but were not interpreted as positive by the study radiologist. In none of these participants was PE diagnosed on the basis of clinical probability, of findings on ancillary studies and three-month follow-up examination, or by another radiologist, unaware of findings, acting as a tiebreaker.
CONCLUSION: Pulmonary CTA findings positive for acute embolism should be viewed with caution, especially if the suspected PE is in a distal segmental or subsegmental artery in a patient with a serum D-dimer level of </=1.0 mug/mL. Furthermore, the Wells criteria may be of limited additional value in this group of patients with low D-dimer levels because most will have low or intermediate clinical probability of PE.
Authors:
Lana Hirai Gimber; R Ing Travis; Jayme M Takahashi; Torrey L Goodman; Hyo-Chun Yoon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Permanente journal     Volume:  13     ISSN:  1552-5775     ISO Abbreviation:  Perm J     Publication Date:  2009  
Date Detail:
Created Date:  2010-08-26     Completed Date:  2011-07-14     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  9800474     Medline TA:  Perm J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4-10     Citation Subset:  -    
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