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Wells rule for pulmonary embolism

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https://www.readbyqxmd.com/read/28815363/the-use-of-natural-language-processing-on-pediatric-diagnostic-radiology-reports-in-the-electronic-health-record-to-identify-deep-venous-thrombosis-in-children
#1
Jorge A Gálvez, Janine M Pappas, Luis Ahumada, John N Martin, Allan F Simpao, Mohamed A Rehman, Char Witmer
Venous thromboembolism (VTE) is a potentially life-threatening condition that includes both deep vein thrombosis (DVT) and pulmonary embolism. We sought to improve detection and reporting of children with a new diagnosis of VTE by applying natural language processing (NLP) tools to radiologists' reports. We validated an NLP tool, Reveal NLP (Health Fidelity Inc, San Mateo, CA) and inference rules engine's performance in identifying reports with deep venous thrombosis using a curated set of ultrasound reports...
August 16, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28806035/a-primer-on-diagnostic-and-financial-implications-of-d-dimer-testing
#2
Kalyan Chakravarthy Potu, Sujithasree Ketineni, Randall Lamfers
Given the high incidence of deep vein thrombosis/pulmonary embolism (DVT/PE) (300,000 to 600,000 per year in the U.S.) and the 30 percent mortality rate associated with undiagnosed PE, diagnostic evaluation is very important. One of the tools used to evaluate for DVT and PE is D-dimer testing. A negative D-dimer test, along with a low Wells clinical probability score, can safely rule out DVT/PE without the need for additional imaging. This approach can reduce cost; however, D-dimer testing is not indicated in all patients...
September 2016: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28721321/correlation-of-ventilation-perfusion-v-q-scan-results-as-compared-with-clinical-probability-of-pulmonary-embolism-in-african-american-population
#3
Fasil Tiruneh, Ahmad Awan, Nicole Hunt, Nahom Tegegn, Daniel Larbi
Introduction Current guidelines suggest the use of the more specific Wells' score could safely reduce the number of unnecessary scans. There is a lack of research to support whether these guidelines apply to the African American population. This study aims to evaluate the correlation of clinical pretest probability of pulmonary embolism (PE) with ventilation-perfusion (V/Q) scan results in a predominantly African American population and to test whether current guidelines based on studies conducted in other populations hold true in this group...
June 14, 2017: Curēus
https://www.readbyqxmd.com/read/28707499/performance-of-wells-score-to-predict-deep-vein-thrombosis-and-pulmonary-embolism-in-endurance-athletes
#4
Amanda L Zaleski, Beth A Taylor, Linda S Pescatello, Paul D Thompson, Craig Denegar
INTRODUCTION: There are an increasing number of reports describing deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in otherwise healthy endurance athletes. The Wells score is the most commonly used clinical prediction rule to diagnose DVT/PE in clinical populations. However, the Wells score may have limited utility for recognition of DVT/PE in athletes, contributing to missed or delayed diagnosis. OBJECTIVE: We performed an analysis of the ability of the Wells score to identify DVT/PE events in athletes through a review of published case reports...
July 21, 2017: Physician and Sportsmedicine
https://www.readbyqxmd.com/read/28683951/diagnosis-and-exclusion-of-pulmonary-embolism
#5
Jeffrey A Kline
BACKGROUND: Failure to test for pulmonary embolism (PE) can be a lethal mistake, but PE and produces symptoms similar to many other diseases. Overtesting for PE has negative consequences. OBJECTIVES: Use published evidence to create a rationale and safe diagnostic approach for ambulatory and emergency patients with suspected PE in 2017. FINDINGS: Pulmonary embolism need not be pursued in patients with no symptoms of PE in the present or recent history (dyspnea, chest pain, cough or syncope), and always normal vital signs...
June 7, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28569924/is-a-normal-computed-tomography-pulmonary-angiography-safe-to-rule-out-acute-pulmonary-embolism-in-patients-with-a-likely-clinical-probability-a-patient-level-meta-analysis
#6
Tom van der Hulle, Nick van Es, Paul L den Exter, Josien van Es, Inge C M Mos, Renée A Douma, Marieke J H A Kruip, Marcel M C Hovens, Marije Ten Wolde, Mathilde Nijkeuter, Hugo Ten Cate, Pieter W Kamphuisen, Harry R Büller, Menno V Huisman, Frederikus A Klok
A normal computed tomography pulmonary angiography (CTPA) remains a controversial criterion for ruling out acute pulmonary embolism (PE) in patients with a likely clinical probability. We set out to determine the risk of VTE and fatal PE after a normal CTPA in this patient category and compare these risk to those after a normal pulmonary angiogram of 1.7 % (95 %CI 1.0-2.7 %) and 0.3 % (95 %CI 0.02-0.7 %). A patient-level meta-analysis from 4 prospective diagnostic management studies that sequentially applied the Wells rule, D-dimer tests and CTPA to consecutive patients with clinically suspected acute PE...
July 26, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28549662/simplified-diagnostic-management-of-suspected-pulmonary-embolism-the-years-study-a-prospective-multicentre-cohort-study
#7
Tom van der Hulle, Whitney Y Cheung, Stephanie Kooij, Ludo F M Beenen, Thomas van Bemmel, Josien van Es, Laura M Faber, Germa M Hazelaar, Christian Heringhaus, Herman Hofstee, Marcel M C Hovens, Karin A H Kaasjager, Rick C J van Klink, Marieke J H A Kruip, Rinske F Loeffen, Albert T A Mairuhu, Saskia Middeldorp, Mathilde Nijkeuter, Liselotte M van der Pol, Suzanne Schol-Gelok, Marije Ten Wolde, Frederikus A Klok, Menno V Huisman
BACKGROUND: Validated diagnostic algorithms in patients with suspected pulmonary embolism are often not used correctly or only benefit subgroups of patients, leading to overuse of computed tomography pulmonary angiography (CTPA). The YEARS clinical decision rule that incorporates differential D-dimer cutoff values at presentation, has been developed to be fast, to be compatible with clinical practice, and to reduce the number of CTPA investigations in all age groups. We aimed to prospectively evaluate this novel and simplified diagnostic algorithm for suspected acute pulmonary embolism...
July 15, 2017: Lancet
https://www.readbyqxmd.com/read/28501724/different-manifestations-of-pulmonary-embolism-in-younger-compared-to-older-patients-clinical-presentation-prediction-rules-and-long-term-outcomes
#8
Izabela E Kiluk, Agnieszka Krajewska, Urszula Kosacka, Agnieszka Tycińska, Robert Milewski, Włodzimierz Musiał, Bożena Sobkowicz
PURPOSE: Data concerning specific manifestations of pulmonary embolism (PE) among younger patients are scarce. We aimed to evaluate differences in clinical presentation, PE prediction rules, thrombolytic treatment use and PE outcomes in younger (<50 years of age) compared to older patients. MATERIAL/METHODS: We studied 238 consecutive patients with proven PE who were retrospectively categorized into three PE probability subgroups according to the revised Geneva score (RGS) and Wells score (WS)...
May 11, 2017: Advances in Medical Sciences
https://www.readbyqxmd.com/read/28439386/usefulness-of-clinical-prediction-rules-d-dimer-and-arterial-blood-gas-analysis-to-predict-pulmonary-embolism-in-cancer-patients
#9
Asifa Karamat, Shazia Awan, Muhammad Ghazanfar Hussain, Fahad Al Hameed, Faheem Butt, Ali Saeed Wahla
OBJECTIVES: Pulmonary embolism (PE) is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules (CPRs) were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas (ABG) analysis and D-dimer in predicting PE in cancer patients. METHODS: Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms (CTPAs) were performed...
March 2017: Oman Medical Journal
https://www.readbyqxmd.com/read/28412719/combined-measurement-of-factor-xiii-and-d-dimer-is-helpful-for-differential-diagnosis-in-patients-with-suspected-pulmonary-embolism
#10
Ning Tang, Ziyong Sun, Dengju Li, Jun Yang, Shiyu Yin, Qing Guan
BACKGROUND: D-dimer has been used to rule out pulmonary embolism (PE). Based on previous reports of decreased concentrations of coagulation factor XIII (FXIII) in venous thromboembolism, and no change in FXIII concentration in patients with acute cardiovascular disease, we evaluated the benefit of simultaneously measuring D-dimer and FXIII concentrations for diagnosing PE. METHODS: In this prospective single-center study, we enrolled 209 patients initially suspected of having PE, and measured their D-dimer and FXIII concentrations...
April 17, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28348360/an-uncommon-case-of-lower-limb-deep-vein-thrombosis-with-multiple-etiological-causes
#11
Jing Miao, Geetha Naik, Sivakumar Muddana, Xiaohuan Li, Supriya Bhimasani, Ronald Alvin Mitchell, Dariush Alaie, Richard L Petrillo
BACKGROUND Deep vein thrombosis (DVT) is a type of venous thromboembolism with diverse clinical and environmental risk factors. Very few cases of DVT with multiple high risk factors have been reported. Here, we report an uncommon DVT case with multiple etiological causes, including appendicitis/appendectomy, morbid obesity, immobilization, positive phosphatidylserine IgG, and heterozygous factor V Leiden mutation. CASE REPORT A 43-year-old female was brought to the emergency room because of 2-week history of pain and swelling and ultrasound revealing evidence of DVT in the right leg...
March 28, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28262522/a-clinically-meaningful-interpretation-of-the-prospective-investigation-of-pulmonary-embolism-diagnosis-pioped-scintigraphic-data
#12
Paul Cronin, Ben A Dwamena
RATIONALE AND OBJECTIVES: Pulmonary embolism (PE) is a common condition associated with significant morbidity and mortality. Diagnostic test characteristics reported in terms of sensitivity and specificity are difficult to translate at the clinical level. More relevant measures are likelihood ratios (LRs), which can convert a pretest into a posttest probability. The aim of our study was to calculate the LRs and posttest probabilities for multiple-level test result for ventilation/perfusion (V/Q) lung scintigraphy and for perfusion scintigraphy combined with chest radiography using modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II and the Prospective Investigative Study of Pulmonary Embolism Diagnosis (PISAPED) criteria for each clinical probability level for the most commonly used clinical prediction rules (CPR) using the PIOPED data...
May 2017: Academic Radiology
https://www.readbyqxmd.com/read/28262243/pitfalls-in-the-diagnostic-management-of-pulmonary-embolism-in-pregnancy
#13
Cécile Tromeur, Liselotte M van der Pol, Frederikus A Klok, Francis Couturaud, Menno V Huisman
Women are at increased risk of venous thromboembolism (VTE) during pregnancy and VTE remains one of the main causes of maternal mortality in developed countries (Konstantinides SV, et al. Eur Heart J 2014; 35(43):3033-69, 69a-69k). Although an accurate diagnosis of acute pulmonary embolism (PE) in pregnant patients is thus of crucial importance, the diagnostic management of suspected PE is challenging for this specific patient category. As D-dimer levels increase physiologically throughout pregnancy, the optimal D-dimer threshold to rule out PE during pregnancy remains unknown...
March 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28185131/external-validation-of-a-claims-based-and-clinical-approach-for-predicting-post-pulmonary-embolism-outcomes-among-united-states-veterans
#14
Christine G Kohn, Erin R Weeda, Neela Kumar, Philip S Wells, W Frank Peacock, Gregory J Fermann, Li Wang, Onur Baser, Jeff R Schein, Concetta Crivera, Craig I Coleman
The In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) rule can accurately identify pulmonary embolism (PE) patients at low risk of early complications using claims data. We sought to externally validate the IMPACT and simplified Pulmonary Embolism Severity Index (sPESI) tools for predicting all-cause mortality and readmission. We used Veteran Health Administration data (10/1/2010-9/30/2015) to identify adults with ≥1 inpatient diagnosis code for acute PE, ≥12 months continuous medical and pharmacy benefits prior to the index PE, ≥90 days of post-event follow-up (unless death occurred) and ≥1 claim for an anticoagulant during the index PE stay...
August 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28009644/imaging-of-nontraumatic-thoracic-emergencies
#15
Lauran Stöger, Cornelia Schaefer-Prokop, Bram H J Geurts
PURPOSE OF REVIEW: Acute chest symptoms form an important incentive for imaging in the emergency setting. This review discusses the radiologic features of various vascular and pulmonary diseases leading to acute respiratory distress and recent developments on important emergency radiologic examinations. RECENT FINDINGS: Recently, triple-rule-out computed tomography protocol was introduced in diagnosis of chest pain, and advancing computed tomography technology and knowledge have led to discussion on treatment of pulmonary embolism...
March 2017: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/28002070/retrospective-validation-of-the-pulmonary-embolism-rule-out-criteria-rule-in-pe-unlikely-patients-with-suspected-pulmonary-embolism
#16
Steven Crane, Tom Jaconelli, Mazin Eragat
INTRODUCTION: Patients presenting to emergency departments (EDs) with suspected pulmonary embolism (PE) can be risk stratified and those who are deemed to be at low risk for PE usually undergo D-dimer testing. A negative D-dimer in this low-risk group rules out PE with a high degree of certainty because of its high sensitivity. The D-dimer is, however, a poorly specific test and positive results often lead to unnecessary radiological imaging (notably computed tomography pulmonary angiography)...
December 19, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/27859891/diagnostic-performance-of-wells-score-combined-with-point-of-care-lung-and-venous-ultrasound-in-suspected-pulmonary-embolism
#17
MULTICENTER STUDY
Peiman Nazerian, Giovanni Volpicelli, Chiara Gigli, Cecilia Becattini, Giuseppe Francesco Sferrazza Papa, Stefano Grifoni, Simone Vanni
OBJECTIVE: Lung and venous ultrasound are bedside diagnostic tools increasingly used in the early diagnostic approach of suspected pulmonary embolism (PE). However, the possibility of improving the conventional prediction rule for PE by integrating ultrasound has never been investigated. METHODS: We performed lung and venous ultrasound in consecutive patients suspected of PE in four emergency departments. Conventional Wells score (Ws) was adjudicated by the attending physician, and ultrasound was performed by one of 20 investigators...
March 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27797317/prevalence-of-pulmonary-embolism-among-patients-hospitalized-for-syncope
#18
Paolo Prandoni, Anthonie W A Lensing, Martin H Prins, Maurizio Ciammaichella, Marica Perlati, Nicola Mumoli, Eugenio Bucherini, Adriana Visonà, Carlo Bova, Davide Imberti, Stefano Campostrini, Sofia Barbar
BACKGROUND: The prevalence of pulmonary embolism among patients hospitalized for syncope is not well documented, and current guidelines pay little attention to a diagnostic workup for pulmonary embolism in these patients. METHODS: We performed a systematic workup for pulmonary embolism in patients admitted to 11 hospitals in Italy for a first episode of syncope, regardless of whether there were alternative explanations for the syncope. The diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability, which was defined according to the Wells score, in combination with a negative d-dimer assay...
October 20, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27783380/common-pitfalls-in-point-of-care-ultrasound-a-practical-guide-for-emergency-and-critical-care-physicians
#19
REVIEW
Pablo Blanco, Giovanni Volpicelli
BACKGROUND: Point-of-care ultrasonography (POCUS) is a widely used tool in emergency and critical care settings, useful in the decision-making process as well as in interventional guidance. While having an impressive diagnostic accuracy in the hands of highly skilled operators, inexperienced practitioners must be aware of some common misinterpretations that may lead to wrong decisions at the bedside. OBJECTIVES: This article provides a revision list of common POCUS misdiagnoses usually found in practice and offers useful tips to recognize and avoid them...
December 2016: Critical Ultrasound Journal
https://www.readbyqxmd.com/read/27764881/update-on-the-treatment-of-venous-thromboembolism
#20
REVIEW
Sam Schulman
During the past 7 years, results from phase III trials comparing nonvitamin antagonist K oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) or with placebo, including 34,900 patients, have been published. Recent guidelines have been updated and now suggest treatment with NOACs rather than with VKA. Other updates in the guidelines concern the initial thrombolytic treatment for selected patients with deep vein thrombosis or pulmonary embolism as well as the possibility of withholding anticoagulation for minimal venous thromboembolism...
November 2016: Seminars in Thrombosis and Hemostasis
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