Clinical Model for Management of Pulmonary Embolism
Authors: Philip Wells, David Anderson, Jeffrey Ginsberg
Journal: Annals of Internal Medicine (1999)

Letters21 September 1999Clinical Model for Management of Pulmonary EmbolismPhilip Wells, MD, MSc, David Anderson, MD, and Jeffrey Ginsberg, MDPhilip Wells, MD, MScUniversity of Ottawa; Ottawa, Ontario K1Y 1J8, Canada (Wells)Dalhousie University; Halifax, Nova Scotia B3H 3W5, Canada (Anderson)McMaster University; Hamilton, Ontario L8N 3Z5, Canada (Ginsberg)Search for more papers by this author, David Anderson, MDUniversity of Ottawa; Ottawa, Ontario K1Y 1J8, Canada (Wells)Dalhousie University; Halifax, Nova Scotia B3H 3W5, Canada (Anderson)McMaster University; Hamilton, Ontario L8N 3Z5, Canada (Ginsberg)Search for more papers by this author, and Jeffrey Ginsberg, MDUniversity of Ottawa; Ottawa, Ontario K1Y 1J8, Canada (Wells)Dalhousie University; Halifax, Nova Scotia B3H 3W5, Canada (Anderson)McMaster University; Hamilton, Ontario L8N 3Z5, Canada (Ginsberg)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-131-6-199909210-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSEWe thank Dr. Pickard for pointing out the two errors in our figures. Pregnant women were excluded because the protocol called for venography or angiography in some situations, and these procedures are relatively contraindicated in pregnancy.Dr. Whitney correctly notes that 5 patients with low pretest probability would be considered to have PE ruled out incorrectly if the negative d-dimer result was relied upon. However, he fails to note that the correct denominator is 521 (that is, <1% of patients would be incorrectly excluded). This number is similar to the negative predictive value of a normal lung scan or ...References1. Schluger N, Henschke C, King T, Russo R, Binkert B, Rackson M, et al . Diagnosis of pulmonary embolism at a large teaching hospital. J Thoracic Imag. 1994;9:180-4. CrossrefMedlineGoogle Scholar2. Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA. 1998;279:458-62. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Philip Wells, MD, MSc; David Anderson, MD; Jeffrey Ginsberg, MDAffiliations: University of Ottawa; Ottawa, Ontario K1Y 1J8, Canada (Wells)Dalhousie University; Halifax, Nova Scotia B3H 3W5, Canada (Anderson)McMaster University; Hamilton, Ontario L8N 3Z5, Canada (Ginsberg) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUse of a Clinical Model for Safe Management of Patients with Suspected Pulmonary Embolism Philip S. Wells , Jeffrey S. Ginsberg , David R. Anderson , Clive Kearon , Michael Gent , Alexander G. Turpie , Janis Bormanis , Jeffrey Weitz , Michael Chamberlain , Dennis Bowie , David Barnes , and Jack Hirsh Clinical Model for Management of Pulmonary Embolism Jeffrey Pickard Clinical Model for Management of Pulmonary Embolism John F. Whitney Clinical Model for Management of Pulmonary Embolism Stephen J. Jay Clinical Model for Management of Pulmonary Embolism Paul Egermayer Metrics Cited byHemostasis and cancer-associated thrombosis: modern prevention and treatment 21 September 1999Volume 131, Issue 6Page: 475KeywordsAngiographyD-dimerLungsNegative predictive valueObesityOral contraceptive therapyPatientsPregnancyPulmonary embolismUltrasound imaging ePublished: 15 August 2000 Issue Published: 21 September 1999 Copyright & PermissionsCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...