Clinical Decision Rules for Excluding Pulmonary Embolism
Authors: Wim Lucassen, Henk C. van Weert, Harry Büller
Journal: Annals of Internal Medicine (2012)

Letters17 January 2012Clinical Decision Rules for Excluding Pulmonary EmbolismWim Lucassen, MD, Henk C. van Weert, MD, PhD, and Harry Büller, MD, PhDWim Lucassen, MDFrom Academic Medical Center, Amsterdam 1100 DD, the Netherlands, and Academic Medical Center, Amsterdam 1105 AZ, the Netherlands.Search for more papers by this author, Henk C. van Weert, MD, PhDFrom Academic Medical Center, Amsterdam 1100 DD, the Netherlands, and Academic Medical Center, Amsterdam 1105 AZ, the Netherlands.Search for more papers by this author, and Harry Büller, MD, PhDFrom Academic Medical Center, Amsterdam 1100 DD, the Netherlands, and Academic Medical Center, Amsterdam 1105 AZ, the Netherlands.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-2-201201170-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Dr. Giusti, Ms. Coerezza, and Ms. Cernuschi for their interesting remarks. Three important issues were addressed: whether a d-dimer test is needed in low-probability patients, the issue of false-positive CT results in low-risk patients, and the adequacy of the outcome measure.A study by Stein and colleagues (1) reported that among patients with a low clinical probability of PE, 42% of CT scans were false-positive. However, the study included all patients with a Wells score less than 2, without using a d-dimer test. The Christopher Study Investigators (2) reported that nearly 50% of low-risk patients (Wells ...References1. Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, et al; PIOPED II Investigators. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317-27. [PMID: 16738268] CrossrefMedlineGoogle Scholar2. van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al; Christopher Study Investigators. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172-9. [PMID: 16403929] CrossrefMedlineGoogle Scholar3. Douma RA, Hofstee HM, Schaefer-Prokop C, van Waesberghe JH, Lely RJ, Kamphuisen PW, et al. Comparison of 4- and 64-slice CT scanning in the diagnosis of pulmonary embolism. Thromb Haemost. 2010;103:242-6. [PMID: 20062931] CrossrefMedlineGoogle Scholar4. Le Gal G, Righini M, Parent F, van Strijen M, Couturaud F. Diagnosis and management of subsegmental pulmonary embolism. J Thromb Haemost. 2006;4:724-31. [PMID: 16634736] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Academic Medical Center, Amsterdam 1100 DD, the Netherlands, and Academic Medical Center, Amsterdam 1105 AZ, the Netherlands.Disclosures: Dr. Lucassen: Grant (money to institution): Dutch Heart Foundation. Dr. van Weert: Grant: Dutch Heart Foundation. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0905. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Decision Rules for Excluding Pulmonary Embolism: A Meta-analysis Wim Lucassen , Geert-Jan Geersing , Petra M.G. Erkens , Johannes B. Reitsma , Karel G.M. Moons , Harry Büller , and Henk C. van Weert Clinical Decision Rules for Excluding Pulmonary Embolism Giuliano Giusti , Anna Coerezza , and Giulia Cernuschi Metrics 17 January 2012Volume 156, Issue 2Page: 169-170KeywordsComputed axial tomographyDecision makingHeartMorbidityPulmonary embolismRadiologistsSafetySpecificity ePublished: 17 January 2012 Issue Published: 17 January 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...