Department of Internal Medicine, Division of Cardiovascular Medicine, University of California Davis, Davis, CA, USA.
Cardiology Section, Department of Veteran Affairs, Northern California Health Care System, Mather, CA, USA.
Biomed Res Int. 2017;2017:4867060. doi: 10.1155/2017/4867060. Epub 2017 Oct 19.
Risk assessment for pulmonary embolism (PE) currently relies on physician judgment, clinical decision rules (CDR), and D-dimer testing. There is still controversy regarding the role of D-dimer testing in low or intermediate risk patients. The objective of the study was to define the role of clinical decision rules and D-dimer testing in patients suspected of having a PE. Records of 894 patients referred for computed tomography pulmonary angiography (CTPA) at a University medical center were analyzed. The clinical decision rules overall had an ROC of approximately 0.70, while signs of DVT had the highest ROC (0.80). A low probability CDR coupled with a negative age-adjusted D-dimer largely excluded PE. The negative predictive value (NPV) of an intermediate CDR was 86-89%, while the addition of a negative D-dimer resulted in NPVs of 94%. Thus, in patients suspected of having a PE, a low or intermediate CDR does not exclude PE; however, in patients with an intermediate CDR, a normal age-adjusted D-dimer increases the NPV.
目前，肺栓塞（PE）的风险评估依赖于医生的判断、临床决策规则（CDR）和 D-二聚体检测。在低危或中危患者中，D-二聚体检测的作用仍存在争议。本研究的目的是确定临床决策规则和 D-二聚体检测在疑似患有 PE 的患者中的作用。分析了在大学医疗中心接受计算机断层肺动脉造影（CTPA）检查的 894 名患者的记录。总的来说，临床决策规则的 ROC 约为 0.70，而深静脉血栓形成的迹象具有最高的 ROC（0.80）。低概率 CDR 加上阴性年龄调整的 D-二聚体基本排除了 PE。中等 CDR 的阴性预测值（NPV）为 86-89%，而阴性 D-二聚体的加入则使 NPV 达到 94%。因此，在疑似患有 PE 的患者中，低危或中危 CDR 不能排除 PE；然而，对于中等 CDR 的患者，正常的年龄调整的 D-二聚体增加了 NPV。
