Perrier A
Clinique de Médecine 1, Hôpital cantonal, Hôpitaux universitaires de Genève.
Rev Mal Respir. 1999 Nov;16(5 Pt 2):927-38.
Decision analysis has greatly benefited to the field of pulmonary embolism diagnosis, by allowing the theoretical assessment of potential novel strategies, which could in turn be validated in clinical trials. The adjunction of clinical probability assessment, plasma D-dimer measurement, and lower limb venous compression ultrasonography, to pulmonary scintigraphy and angiography in the diagnostic workup, results in a considerable reduction in the requirement for angiography. Moreover, these strategies are highly cost-effective, yielding cost savings without increasing morbidity or mortality. Such diagnostic algorithms are safe, as demonstrated by clinical outcome studies. Finally, spiral CTscan combined with D-dimer and ultrasonography could also prove highly cost-effective, and replace either pulmonary angiography, or even both lung scan and angiography, if ongoing studies confirm the promising preliminary results obtained with CTscan. However, such a conclusion awaits the validation of algorithms including CTscan by clinical outcome trials, in which the therapeutic decision would rest on the result of the spiral CTscan.
决策分析通过对潜在新策略进行理论评估，极大地促进了肺栓塞诊断领域的发展，这些新策略反过来又可在临床试验中得到验证。在诊断检查中，将临床概率评估、血浆D - 二聚体测量和下肢静脉压迫超声检查与肺闪烁扫描和血管造影相结合，可大幅减少血管造影的需求。此外，这些策略具有很高的成本效益，在不增加发病率或死亡率的情况下节省了成本。临床结果研究表明，此类诊断算法是安全的。最后，如果正在进行的研究证实了CT扫描所取得的有前景的初步结果，那么螺旋CT扫描结合D - 二聚体和超声检查也可能被证明具有很高的成本效益，并可替代肺血管造影，甚至同时替代肺部扫描和血管造影。然而，这样的结论有待通过临床结果试验对包括CT扫描在内的算法进行验证，其中治疗决策将基于螺旋CT扫描的结果。
