Strategy That Includes Serial Noninvasive Leg Tests for Diagnosis of Thromboembolic Disease in Patients With Suspected Acute Pulmonary Embolism Based on Data From PIOPED

摘要: Objective: To estimate the percentage of patients with suspected acute pulmonary embolism in whom a noninvasive diagnosis or exclusion thromboembolic disease might be safely made on basis ventilation-perfusion (VQ) lung scans, single tests lower extremities, and, adequate cardiorespiratory reserve, serial extremities. Methods: Calculations were among 662 who participated collaborative study Prospective Investigation Pulmonary Embolism Diagnosis (PIOPED) and had blood gas values measured while breathing room air underwent angiography. The diagnostic strategy recommends treatment all high-probability VQ scan no nearly normal scans. In nondiagnostic scans (intermediate- low-probability scans), leg test is recommended. It was assumed that 50% would show deep venous thrombosis test. If results are abnormal, indicated. normal, Treatment can withheld if normal. poor angiography Results: A therefore, eliminate need for 53 (11%) 468 (95% confidence interval [CI], 9% to 15%) otherwise require Serial reserve result either exclude it 222 (47%) CI, 43% 52%). angiography, reduced from (71%) 67% 74%) performed 415 (63%) 59% 66%) only performed, further 193 (29%) 26% 33%) used where appropriate. Conclusion: includes tests, permit safe 71% embolism. (Arch Intern Med. 1995;155:2101-2104)