Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
J Thromb Haemost. 2009 Oct;7(10):1633-8. doi: 10.1111/j.1538-7836.2009.03572.x. Epub 2009 Aug 11.
Childhood pulmonary embolism (PE) causes significant mortality and evidence suggests that it is under-diagnosed. Clinical probability scores and D-dimer estimation to assess pre-test probability have not been studied in children with suspected PE.
PATIENTS/METHODS: This retrospective cohort study evaluated Wells simplified probability score for PE in 50 children with PE and 25 PE negative control patients, and D-dimer values in 27 PE positive and 12 PE negative children.
PE positive and PE negative groups had similar rates of risk factors for venous thromboembolism (VTE). Wells simplified probability score showed a small difference between PE positive and PE negative children (median score: PE positive, 4.5; PE negative, 4; P = 0.009), children with PE are more likely to obtain a 'PE likely' score (score > 4), P = 0.012. The difference was of slightly greater significance when the Wells score was adjusted to account for pediatric normal ranges for heart rate, P = 0.007, and signs/symptoms of upper limb DVT, P = 0.006. Children with PE were as likely as PE negative patients to have a D-dimer value within the normal range (PE positive, 15%; PE negative, 25%; P = 0.654). A combination of a 'PE unlikely' score and normal D-dimer value occurred in 1/12 (8%) of PE negative children.
The Wells clinical probability score and D-dimer estimation may lack utility in the determination of pre-test probability of PE in children. Validation of a pediatric clinical probability score, incorporating D-dimer estimation, by prospective study, would be difficult as a result of the rarity of childhood PE.
儿童肺栓塞（PE）死亡率高，有证据表明其诊断不足。尚未研究过临床可能性评分和 D-二聚体估计值在疑似 PE 的儿童中的应用。
患者/方法：本回顾性队列研究评估了 50 例 PE 患儿和 25 例 PE 阴性对照患儿的 Wells 简化 PE 可能性评分，以及 27 例 PE 阳性患儿和 12 例 PE 阴性患儿的 D-二聚体值。
PE 阳性和 PE 阴性组静脉血栓栓塞（VTE）危险因素发生率相似。PE 阳性和 PE 阴性患儿的 Wells 简化可能性评分存在差异（中位数评分：PE 阳性，4.5；PE 阴性，4；P = 0.009），PE 患儿更有可能获得“PE 可能性大”评分（评分>4），P = 0.012。当 Wells 评分调整以考虑儿科心率、P = 0.007 和上肢 DVT 体征/症状的正常范围时，差异更具统计学意义，P = 0.006。PE 患儿与 PE 阴性患者一样，D-二聚体值在正常范围内的可能性相同（PE 阳性，15%；PE 阴性，25%；P = 0.654）。PE 阴性患儿中，有 1/12（8%）的患儿“PE 可能性小”评分和正常 D-二聚体值同时存在。
在确定儿童 PE 的术前可能性时，Wells 临床可能性评分和 D-二聚体估计值可能没有用处。由于儿童 PE 罕见，前瞻性研究验证纳入 D-二聚体估计值的儿科临床可能性评分将非常困难。
