Publication

C0197: Optimization of the diagnostic management of clinically suspected pulmonary embolism in hospitalized patients

Van Der Hulle, T., Den Exter, P., Mos, I., Kamphuisen, P., Hovens, M., Kruip, M., Van Es, J., Ten Cate, H., Huisman, M. & Klok, E., May-2014, In : Thrombosis Research. 133, p. 32 1 p.

Research output: Contribution to journalMeeting AbstractAcademic

  • T. Van Der Hulle
  • P. Den Exter
  • I. Mos
  • P. Kamphuisen
  • M. Hovens
  • M. Kruip
  • J. Van Es
  • H. Ten Cate
  • M. Huisman
  • E. Klok
Background: Identical diagnostic algorithms for suspected pulmonary embolism (PE) [clinical decision rule (CDR) followed by D-dimer testing and/or computed tomography pulmonary angiography (CTPA)] are used for in-and outpatients, while D-dimer levels, risk factors and pre-test probability for PE differ. We firstly evaluated the efficacy of the standard algorithm in a validation cohort of inpatients and secondly aimed to optimize the algorithm in this cohort combined with a previous cohort of inpatients. Methods: Efficiency (number of CTPAs) and safety (3-month venous thromboembolism (VTE) incidence rates) of the standard algorithm were studied in a validation cohort.We further studied the potential of increasing the D-dimer threshold and/or the CDR threshold in this and a previous cohort and derived a new CDR based on a multivariate regression analysis. Results: In the validation cohort (n = 140), only 2% (3/140; 95% CI 0.4-6.1) were managed without CTPA. Combining two cohorts (n = 624), overall PE prevalence was 25%, standard management resulted in a 3-month VTE incidence rate of 0.0% (95% CI 0.0-7.3) and 92% of patients underwent CTPA. Applying an age-adjusted D-dimer threshold resulted in a-4.5 percentage points (95% CI 1.2-7.8) reduction of CTPAs with a VTE incidence rate of 1.9% (95% CI 0.9-3.6%). None of the other adjustments, nor the newly derived CDR, resulted in a higher efficiency with an acceptable failure rate. Conclusions: The standard CDR combined with the age-adjusted D-dimer threshold resulted in a limited increase of efficiency with an acceptable failure rate. Our additional attempts to safely reduce the high need for CTPA were unsuccessful.
Original languageEnglish
Pages (from-to)32
Number of pages1
JournalThrombosis Research
Volume133
Publication statusPublished - May-2014
Event23rd MLTD Biennial International Congress on Thrombosis - Valencia, Spain
Duration: 14-May-201417-May-2014

Event

23rd MLTD Biennial International Congress on Thrombosis

14/05/201417/05/2014

Spain

Event: Conference

    Keywords

  • D dimer, lung embolism, hospital patient, human, thrombosis, diagnosis, algorithm, incidence, venous thromboembolism, safety, outpatient, lung angiography, risk factor, prevalence, computer assisted tomography, regression analysis, patient

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