И ешё раз про лёгочный тромбоемболизм.

[FRSM]

Doctors can safely switch to simpler decision rules for suspected pulmonary embolus

Ann Intern Med2011;154:709-18

The four most popular clinical decision rules are equally good at ruling out a pulmonary embolus when combined with a D-dimer test, according to a prospective study from the Netherlands.

Researchers compared the Wells rule, the revised Geneva score, and newer simpler versions of both in 807 adults presenting to hospital with a suspected pulmonary embolus. All adults had the same work-up, which included all four clinical decision rules and a D-dimer test. Those judged unlikely to have an embolus by all four rules, and with a normal D-dimer test, were sent home with no further investigations or treatment. The rest had a diagnostic computed tomography scan, followed by anticoagulation for confirmed cases.

Researchers tracked all patients for three months, to pick up any emboli missed by the work-up and to compute performance characteristics of the four individual clinical decision rules. There was little to choose between them. When combined with a D-dimer test, all four had negative predictive values above 99%. The simplified scores were as accurate as their more complex forerunners, and the authors say doctors can safely switch to their simplified rule of choice. The simplified revised Geneva score and a D-dimer test, for example, ruled out a pulmonary embolus in 190 patients. Just one had a diagnosis of venous thromboembolism during follow-up (0.5%, 95% CI 0.0% to 2.9%).