Galipienzo J, Garcia de Tena J, Flores J, Alvarez C, Garcia-Avello A, Arribas I
Servicio de Anestesiología y Reanimación, Hospital Universitario de Fuenlabrada. Fuenlabrada, Spain.
Rom J Intern Med. 2012 Jul-Sep;50(3):195-202.
The aim of our study was to assess the clinical effectiveness of a simplified algorithm using the Wells clinical decision rule, D-dimer testing, and computed tomography (CT) in patients with suspected pulmonary embolism (PE) in an Emergency Department (ED).
Patients with clinically suspected PE from the Emergency Department were included from May 2007 through December 2008. Clinical probability was assessed using the Wells clinical decision rule and a VIDAS D-dimer assay was used to measure D-dimer concentration. Patients were categorized as "pulmonary embolism unlikely" or "pulmonary embolism likely" using the dichotomized version of the Wells clinical decision rule. Pulmonary embolism was considered excluded in patients with unlikely probability and normal D-dimer test (< 500 ng/ml). All other patients underwent CT, and pulmonary embolism was considered present or excluded based on the results. Anticoagulants were withheld from patients classified as excluded, and all patients were followed up for 3 months.
241 patients were included in the study. The prevalence of PE in the entire population was 23.6%. The combination of unlikely probability using the dichotomized Wells clinical decision rule and a normal D-dimer level occurred in 23.6%, thus making CT unnecessary. During the followup period, no thromboembolic events were recorded and there were no deaths related to venous thromboembolic disease (3-month thromboembolic risk 0% [95% CI, 0%-8%]).
In this study we have confirmed the effectiveness of a diagnostic management strategy using a simple clinical decision rule, D-dimer testing, and CT in the evaluation and management of patients with clinically suspected pulmonary embolism.
本研究旨在评估在急诊科（ED）对疑似肺栓塞（PE）患者使用简化算法（采用韦尔斯临床决策规则、D - 二聚体检测和计算机断层扫描（CT））的临床有效性。
纳入2007年5月至2008年12月急诊科临床疑似PE的患者。使用韦尔斯临床决策规则评估临床概率，并采用VIDAS D - 二聚体检测法测量D - 二聚体浓度。使用韦尔斯临床决策规则的二分法版本将患者分为“肺栓塞可能性低”或“肺栓塞可能性高”。肺栓塞可能性低且D - 二聚体检测正常（<500 ng/ml）的患者被认为可排除肺栓塞。所有其他患者接受CT检查，并根据结果判断肺栓塞是否存在或排除。被分类为排除的患者停用抗凝剂，所有患者随访3个月。
241例患者纳入研究。整个人群中PE的患病率为23.6%。使用二分法韦尔斯临床决策规则且D - 二聚体水平正常的可能性低的情况占23.6%，因此无需进行CT检查。在随访期间，未记录到血栓栓塞事件，也没有与静脉血栓栓塞性疾病相关的死亡（3个月血栓栓塞风险为0% [95% CI，0% - 8%]）。
在本研究中，我们证实了使用简单临床决策规则、D - 二聚体检测和CT的诊断管理策略在评估和管理临床疑似肺栓塞患者中的有效性。
