Hogg Kerstin, Dawson Deborah, Tabor Ted, Tabor Beverly, Mackway-Jones Kevin
Emergency Medicine Research Group, Emergency Department, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL UK.
Chest. 2005 Oct;128(4):2195-202. doi: 10.1378/chest.128.4.2195.
Pleuritic chest pain is a common presenting condition in the emergency department. A noninvasive bedside rule out test for pulmonary embolism would aid investigating this patient group. Our study aimed to compare the clinical utility of three methods for calculating respiratory dead space in the diagnosis of pulmonary embolism in outpatients with pleuritic chest pain.
Prospective diagnostic study.
Large city-center emergency department.
Between February 2002 and June 2003, 425 patients presenting to the emergency department with pleuritic chest pain were prospectively recruited.
Data collection for respiratory dead space was performed in the emergency department by two researchers. The respiratory dead space fraction was calculated independently using three different methods. All patients underwent an independent reference standard diagnostic algorithm to establish the presence or absence of pulmonary embolism. Those with a low modified Wells clinical probability and a normal quantitative d-dimer finding were discharged home. All others followed a reference standard protocol using Prospective Investigation of Pulmonary Embolism Diagnosis-interpreted ventilation/perfusion scanning, CT pulmonary angiography, and digital subtraction pulmonary angiography. All patients were followed up clinically for 3 months.
For the Bohr calculation, the area under the receiver operating characteristic curve was 0.62 (95% confidence interval [CI], 0.51 to 0.73), the Enghoff calculation was 0.66 (95% CI, 0.55 to 0.77), and the capillary sample Enghoff was 0.62 (95% CI, 0.49 to 0.65). The optimum Bohr cutoff value gave 100.0% sensitivity (95% CI, 84.5 to 100%) but a low specificity of 22.7% (95% CI, 18.8 to 27.2%). The optimum cutoff points for Enghoff and capillary Enghoff calculations gave sensitivities of 95.3% (95% CI, 77.3 to 99.2%) and 94.4% (95% CI, 74.2 to 99.0%), respectively, with poor specificity.
Respiratory dead space analysis does not perform well as a stand-alone diagnostic test for pulmonary embolism in outpatients presenting with pleuritic chest pain.
胸膜炎性胸痛是急诊科常见的就诊症状。一种用于排除肺栓塞的无创床旁检测方法将有助于对这组患者进行检查。我们的研究旨在比较三种计算呼吸死腔的方法在诊断胸膜炎性胸痛门诊患者肺栓塞中的临床效用。
前瞻性诊断研究。
大型市中心急诊科。
在2002年2月至2003年6月期间，前瞻性招募了425例因胸膜炎性胸痛到急诊科就诊的患者。
由两名研究人员在急诊科收集呼吸死腔的数据。使用三种不同方法独立计算呼吸死腔分数。所有患者均接受独立的参考标准诊断算法，以确定是否存在肺栓塞。改良Wells临床概率低且定量D - 二聚体结果正常的患者出院回家。所有其他患者遵循参考标准方案，采用肺栓塞诊断前瞻性调查解读的通气/灌注扫描、CT肺动脉造影和数字减影肺动脉造影。所有患者均进行了3个月的临床随访。
对于玻尔计算法，受试者工作特征曲线下面积为0.62（95%置信区间[CI]，0.51至0.73），恩霍夫计算法为0.66（95%CI，0.55至0.77），毛细血管样本恩霍夫计算法为0.62（95%CI，0.49至0.65）。最佳玻尔临界值的灵敏度为100.0%（95%CI，84.5至100%），但特异性低，为22.7%（95%CI，18.8至27.2%）。恩霍夫计算法和毛细血管恩霍夫计算法的最佳临界值灵敏度分别为95.3%（95%CI，77.3至99.2%）和94.4%（95%CI，74.2至99.0%），特异性较差。
对于以胸膜炎性胸痛就诊的门诊患者，呼吸死腔分析作为肺栓塞的独立诊断测试效果不佳。
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