Worsley D F, Palevsky H I, Alavi A
Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia.
Arch Intern Med. 1994;154(23):2737-41. doi: 10.1001/archinte.1994.00420230134016.
To determine the clinical characteristics of patients with pulmonary embolism (PE) and low- or very-low-probability ventilation-perfusion lung scan interpretations.
A retrospective analysis of the data obtained during the Prospective Investigation of Pulmonary Embolism Diagnosis study was performed. The clinical characteristics of patients with acute PE and low- or very-low-probability lung scan interpretation (false-negative interpretations) were compared with patients who had low- or very-low-probability lung scan interpretations and no evidence of acute PE (true-negative interpretations).
Of the 1493 patients who gave consent to participate in the Prospective Investigation of Pulmonary Embolism Diagnosis study, 399 patients had angiographic or autopsy evidence of acute PE. Pulmonary embolism was excluded in 960 patients. Patients with false-negative lung scan interpretations more commonly had a history of immobilization (P < .0001), trauma to the lower extremities (P < .003), recent surgery (P < .002), or central venous instrumentation (P < .04) compared with patients with true-negative lung scan interpretations. In patients with low- or very-low-probability lung scan interpretations and none of the above-mentioned risk factors, the prevalence of PE was only 4.5%. In contrast, for patients with low- or very-low-probability lung scan interpretations and two or more of the above-mentioned risk factors, the prevalence of PE was 21%.
Patients with a history of immobilization, trauma to the lower extremities, recent surgery, or central venous instrumentation were more likely to have false-negative lung scan interpretations. Therefore, this population warrants special attention when deciding on the need for peripheral venous studies or angiography in patients with low- or very-low-probability lung scan interpretation.
确定肺栓塞（PE）患者以及通气灌注肺扫描结果为低概率或极低概率的患者的临床特征。
对在肺栓塞诊断前瞻性研究期间获得的数据进行回顾性分析。将急性PE且肺扫描结果为低概率或极低概率（假阴性结果）的患者的临床特征与肺扫描结果为低概率或极低概率且无急性PE证据（真阴性结果）的患者进行比较。
在1493名同意参与肺栓塞诊断前瞻性研究的患者中，399名患者有急性PE的血管造影或尸检证据。960名患者排除了肺栓塞。与肺扫描真阴性结果的患者相比，肺扫描假阴性结果的患者更常伴有制动史（P <.0001）、下肢创伤（P <.003）、近期手术（P <.002）或中心静脉置管史（P <.04）。在肺扫描结果为低概率或极低概率且无上述任何危险因素的患者中，PE的患病率仅为4.5%。相比之下，对于肺扫描结果为低概率或极低概率且有两种或更多上述危险因素的患者，PE的患病率为21%。
有制动史、下肢创伤、近期手术或中心静脉置管史的患者更有可能出现肺扫描假阴性结果。因此，在对肺扫描结果为低概率或极低概率的患者决定是否需要进行外周静脉研究或血管造影时，这一人群值得特别关注。
