| Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism. | |
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MedLine Citation:
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PMID: 11453707 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Helical computed tomography (CT) is commonly used to diagnose pulmonary embolism, although its operating characteristics have been insufficiently evaluated. OBJECTIVE: To assess the sensitivity and specificity of helical CT in suspected pulmonary embolism. DESIGN: Observational study. SETTING: Emergency department of a teaching and community hospital. PATIENTS: 299 patients with clinically suspected pulmonary embolism and a plasma D -dimer level greater than 500 microgram/L. INTERVENTION: Pulmonary embolism was established by using a validated algorithm that included clinical assessment, lower-limb compression ultrasonography, lung scanning, and pulmonary angiography. MEASUREMENTS: Sensitivity, specificity, and likelihood ratios of helical CT and interobserver agreement. Helical CT scans were withheld from clinicians and were read 3 months after acquisition by radiologists blinded to all clinical data. RESULTS: 118 patients (39%) had pulmonary embolism. In 12 patients (4%), 2 of whom had pulmonary embolism, results of helical CT were inconclusive. For patients with conclusive results, sensitivity of helical CT was 70% (95% CI, 62% to 78%) and specificity was 91% (CI, 86% to 95%). Interobserver agreement was high (kappa = 0.823 to 0.902). The false-negative rate was lower for helical CT used after initial negative results on ultrasonography than for helical CT alone (21% vs. 30%). Use of helical CT after normal results on initial ultrasonography and nondiagnostic results on lung scanning had a false-negative rate of only 5% and a false-positive rate of only 7%. CONCLUSION: Helical CT should not be used alone for suspected pulmonary embolism but could replace angiography in combined strategies that include ultrasonography and lung scanning. |
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Authors:
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A Perrier; N Howarth; D Didier; P Loubeyre; P F Unger; P de Moerloose; D Slosman; A Junod; H Bounameaux |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of internal medicine Volume: 135 ISSN: 0003-4819 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2001 Jul |
Date Detail:
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Created Date: 2001-07-16 Completed Date: 2001-07-26 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 88-97 Citation Subset: AIM; IM |
Affiliation:
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Medical Clinic 1, Department of Internal Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland. Arnaud.Perrier@medecine.unige.ch |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Algorithms Canada Decision Trees* Emergency Service, Hospital* Female Fibrin Fibrinogen Degradation Products / analysis Follow-Up Studies Humans Male Middle Aged Observer Variation Prospective Studies Pulmonary Embolism / diagnosis, radiography* Sensitivity and Specificity Single-Blind Method Tomography, X-Ray Computed / methods* |
| Chemical | |
Reg. No./Substance:
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0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D |
| Comments/Corrections | |
Comment In:
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ACP J Club. 2002 Jan-Feb;136(1):30
[PMID:
11829571
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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