Should Patients Be Managed for Suspected Pulmonary Embolism on the Basis of Pretest Clinical Probability and <scp>d</scp>-dimer Results?
Authors: Paul E. Sijens, Matthijs Oudkerk
Journal: Annals of Internal Medicine (2002)

Letters21 May 2002Should Patients Be Managed for Suspected Pulmonary Embolism on the Basis of Pretest Clinical Probability and d-dimer Results?Paul E. Sijens, MD, PhD and Matthijs Oudkerk, MD, PhDPaul E. Sijens, MD, PhDUniversity Hospital Groningen; Groningen 9300 RB, the Netherlands (Sijens, Oudkerk)Search for more papers by this author and Matthijs Oudkerk, MD, PhDUniversity Hospital Groningen; Groningen 9300 RB, the Netherlands (Sijens, Oudkerk)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-136-10-200205210-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Wells and colleagues (1) conclude that managing patients for suspected pulmonary embolism on the basis of pretest clinical probability and d-dimer results is safe and decreases the need for diagnostic imaging. Although we appreciate the size and conduct of the study, we believe the data do not support this conclusion. Without d-dimer testing, the negative predictive value in the low-probability group is 98.7% (95% CI, 97.3% to 99.5%), which is not significantly different from the value obtained with d-dimer testing (99.5% [CI, 98.4% to 99.9%]). In addition, patients with low probability have a low prevalence of pulmonary ...References1. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al . Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135:98-107. [PMID: 11453709] LinkGoogle Scholar2. Sijens PE, van Ingen HE, van Beek EJ, Berghout A, Oudkerk M. Rapid ELISA assay for plasma d-dimer in the diagnosis of segmental and subsegmental pulmonary embolism. A comparison with pulmonary angiography. Thromb Haemost. 2000;84:156-9. [PMID: 10959684] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Paul E. Sijens, MD, PhD; Matthijs Oudkerk, MD, PhDAffiliations: University Hospital Groningen; Groningen 9300 RB, the Netherlands (Sijens, Oudkerk) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoExcluding Pulmonary Embolism at the Bedside without Diagnostic Imaging: Management of Patients with Suspected Pulmonary Embolism Presenting to the Emergency Department by Using a Simple Clinical Model and d-dimer Philip S. Wells , David R. Anderson , Marc Rodger , Ian Stiell , Jonathan F. Dreyer , David Barnes , Melissa Forgie , George Kovacs , John Ward , and Michael J. Kovacs Metrics Cited bySimplifying the diagnosis of pulmonary embolismA prospective reassessment of the utility of the Wells score in identifying pulmonary embolism 21 May 2002Volume 136, Issue 10 Page: 781 Keywords D-dimer Diagnostic imaging Negative predictive value Pulmonary embolism ePublished: 21 May 2002 Issue Published: 21 May 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...