Does a Clinical Decision Rule Using D-Dimer Level Improve the Yield of Pulmonary CT Angiography?
The objective of our study was to evaluate the impact of incorporating a mandatory clinical decision rule and selective d-dimer use on the yield of pulmonary CT angiography (CTA). Guidelines incorporating a clinical decision rule (Wells score: range, 0-12.5) and a highly sensitive d-dimer assay as d...
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| Veröffentlicht in: | American journal of roentgenology (1976) 2011-05, Vol.196 (5), p.1059-1064 |
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| container_title | American journal of roentgenology (1976) |
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| creator | SOO HOO, Guy W WU, Carol C VAZIRANI, Sondra ZHAOPING LI BARACK, Bruce M |
| description | The objective of our study was to evaluate the impact of incorporating a mandatory clinical decision rule and selective d-dimer use on the yield of pulmonary CT angiography (CTA).
Guidelines incorporating a clinical decision rule (Wells score: range, 0-12.5) and a highly sensitive d-dimer assay as decision points were placed into a computerized order entry menu. From December 2006 through November 2008, 261 pulmonary CTA examinations of 238 men and 14 women (mean age ± SD, 65 ± 12 years; range, 31-92 years) were performed. Eight patients underwent more than one pulmonary CTA examination. Charts were reviewed. The results of pulmonary CTA, the clinical decision rule, and d-dimer level (if obtained) were analyzed with the Student t test, chi-square test, or other comparisons using statistical software (MedCalc, version 11.0).
Of the pulmonary CTA examinations, 16.5% (43/261) were positive for pulmonary embolism (PE) compared with 3.1% (6/196) during the previous 2 years. The mean clinical decision rule score and mean d-dimer level were 5.5 ± 2.4 (SD) and 4956 ± 2892 ng/mL, respectively, for those with PE compared with 4.5 ± 2.1 and 2398 ± 2100 ng/mL for those without PE (both, p < 0.01). The negative predictive value of a clinical decision rule score of 4 or less and d-dimer level of less than 1000 ng/mL was 1.0. A clinical decision rule of greater than 4 and a higher d-dimer level were better predictors for PE, especially a d-dimer level of greater than 3000 ng/mL (odds ratio = 6.69; 95% CI = 2.72-16.43).
Guidelines combining a clinical decision rule with d-dimer level significantly improved the utilization of pulmonary CTA and positive yield for PE. |
| doi_str_mv | 10.2214/AJR.10.4200 |
| format | Article |
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Guidelines incorporating a clinical decision rule (Wells score: range, 0-12.5) and a highly sensitive d-dimer assay as decision points were placed into a computerized order entry menu. From December 2006 through November 2008, 261 pulmonary CTA examinations of 238 men and 14 women (mean age ± SD, 65 ± 12 years; range, 31-92 years) were performed. Eight patients underwent more than one pulmonary CTA examination. Charts were reviewed. The results of pulmonary CTA, the clinical decision rule, and d-dimer level (if obtained) were analyzed with the Student t test, chi-square test, or other comparisons using statistical software (MedCalc, version 11.0).
Of the pulmonary CTA examinations, 16.5% (43/261) were positive for pulmonary embolism (PE) compared with 3.1% (6/196) during the previous 2 years. The mean clinical decision rule score and mean d-dimer level were 5.5 ± 2.4 (SD) and 4956 ± 2892 ng/mL, respectively, for those with PE compared with 4.5 ± 2.1 and 2398 ± 2100 ng/mL for those without PE (both, p < 0.01). The negative predictive value of a clinical decision rule score of 4 or less and d-dimer level of less than 1000 ng/mL was 1.0. A clinical decision rule of greater than 4 and a higher d-dimer level were better predictors for PE, especially a d-dimer level of greater than 3000 ng/mL (odds ratio = 6.69; 95% CI = 2.72-16.43).
Guidelines combining a clinical decision rule with d-dimer level significantly improved the utilization of pulmonary CTA and positive yield for PE.</description><identifier>ISSN: 0361-803X</identifier><identifier>EISSN: 1546-3141</identifier><identifier>DOI: 10.2214/AJR.10.4200</identifier><identifier>PMID: 21512071</identifier><identifier>CODEN: AAJRDX</identifier><language>eng</language><publisher>Reston, VA: American Roentgen Ray Society</publisher><subject>Aged ; Angiography - utilization ; Biological and medical sciences ; Cardiovascular system ; Clinical Protocols ; Cohort Studies ; Decision Support Techniques ; Female ; Fibrin Fibrinogen Degradation Products - metabolism ; Guideline Adherence ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Patient Selection ; Pneumology ; Predictive Value of Tests ; Pulmonary Embolism - blood ; Pulmonary Embolism - diagnosis ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Retrospective Studies ; Tomography, X-Ray Computed - utilization</subject><ispartof>American journal of roentgenology (1976), 2011-05, Vol.196 (5), p.1059-1064</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c318t-6485244d8d349454be392b8eaa26035dcf3dd33f84725a5d7292ace12d5445723</citedby><cites>FETCH-LOGICAL-c318t-6485244d8d349454be392b8eaa26035dcf3dd33f84725a5d7292ace12d5445723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4106,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24122949$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21512071$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SOO HOO, Guy W</creatorcontrib><creatorcontrib>WU, Carol C</creatorcontrib><creatorcontrib>VAZIRANI, Sondra</creatorcontrib><creatorcontrib>ZHAOPING LI</creatorcontrib><creatorcontrib>BARACK, Bruce M</creatorcontrib><title>Does a Clinical Decision Rule Using D-Dimer Level Improve the Yield of Pulmonary CT Angiography?</title><title>American journal of roentgenology (1976)</title><addtitle>AJR Am J Roentgenol</addtitle><description>The objective of our study was to evaluate the impact of incorporating a mandatory clinical decision rule and selective d-dimer use on the yield of pulmonary CT angiography (CTA).
Guidelines incorporating a clinical decision rule (Wells score: range, 0-12.5) and a highly sensitive d-dimer assay as decision points were placed into a computerized order entry menu. From December 2006 through November 2008, 261 pulmonary CTA examinations of 238 men and 14 women (mean age ± SD, 65 ± 12 years; range, 31-92 years) were performed. Eight patients underwent more than one pulmonary CTA examination. Charts were reviewed. The results of pulmonary CTA, the clinical decision rule, and d-dimer level (if obtained) were analyzed with the Student t test, chi-square test, or other comparisons using statistical software (MedCalc, version 11.0).
Of the pulmonary CTA examinations, 16.5% (43/261) were positive for pulmonary embolism (PE) compared with 3.1% (6/196) during the previous 2 years. The mean clinical decision rule score and mean d-dimer level were 5.5 ± 2.4 (SD) and 4956 ± 2892 ng/mL, respectively, for those with PE compared with 4.5 ± 2.1 and 2398 ± 2100 ng/mL for those without PE (both, p < 0.01). The negative predictive value of a clinical decision rule score of 4 or less and d-dimer level of less than 1000 ng/mL was 1.0. A clinical decision rule of greater than 4 and a higher d-dimer level were better predictors for PE, especially a d-dimer level of greater than 3000 ng/mL (odds ratio = 6.69; 95% CI = 2.72-16.43).
Guidelines combining a clinical decision rule with d-dimer level significantly improved the utilization of pulmonary CTA and positive yield for PE.</description><subject>Aged</subject><subject>Angiography - utilization</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>Clinical Protocols</subject><subject>Cohort Studies</subject><subject>Decision Support Techniques</subject><subject>Female</subject><subject>Fibrin Fibrinogen Degradation Products - metabolism</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patient Selection</subject><subject>Pneumology</subject><subject>Predictive Value of Tests</subject><subject>Pulmonary Embolism - blood</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed - utilization</subject><issn>0361-803X</issn><issn>1546-3141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkEtLAzEUhYMotlZX7iUbcSFT87iZx0pK65OCIgq6GtPJnRrJzNRJR-i_N6VVV-csPg6Hj5BjzoZCcLgY3T8NQwfB2A7pcwVxJDnwXdJnMuZRyuRrjxx4_8kYS9Is2Sc9wRUXLOF98j5p0FNNx87WttCOTrCw3jY1feoc0hdv6zmdRBNbYUun-I2O3lWLtvlGuvxA-mbRGdqU9LFzVVPrdkXHz3RUz20zb_XiY3V5SPZK7TwebXNAXq6vnse30fTh5m48mkaF5OkyiiFVAsCkRkIGCmYoMzFLUWsRM6lMUUpjpCxTSITSyiQiE7pALowCUImQA3K22Q3nvjr0y7yyvkDndI1N5_M0liAlxBDI8w1ZtI33LZb5orVVuJ5zlq-N5sHouq-NBvpku9vNKjR_7K_CAJxuAe2DwLLVdTD4zwEXIoNM_gBi6Xtk</recordid><startdate>20110501</startdate><enddate>20110501</enddate><creator>SOO HOO, Guy W</creator><creator>WU, Carol C</creator><creator>VAZIRANI, Sondra</creator><creator>ZHAOPING LI</creator><creator>BARACK, Bruce M</creator><general>American Roentgen Ray Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110501</creationdate><title>Does a Clinical Decision Rule Using D-Dimer Level Improve the Yield of Pulmonary CT Angiography?</title><author>SOO HOO, Guy W ; WU, Carol C ; VAZIRANI, Sondra ; ZHAOPING LI ; BARACK, Bruce M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c318t-6485244d8d349454be392b8eaa26035dcf3dd33f84725a5d7292ace12d5445723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Angiography - utilization</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>Clinical Protocols</topic><topic>Cohort Studies</topic><topic>Decision Support Techniques</topic><topic>Female</topic><topic>Fibrin Fibrinogen Degradation Products - metabolism</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patient Selection</topic><topic>Pneumology</topic><topic>Predictive Value of Tests</topic><topic>Pulmonary Embolism - blood</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Retrospective Studies</topic><topic>Tomography, X-Ray Computed - utilization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SOO HOO, Guy W</creatorcontrib><creatorcontrib>WU, Carol C</creatorcontrib><creatorcontrib>VAZIRANI, Sondra</creatorcontrib><creatorcontrib>ZHAOPING LI</creatorcontrib><creatorcontrib>BARACK, Bruce M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of roentgenology (1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SOO HOO, Guy W</au><au>WU, Carol C</au><au>VAZIRANI, Sondra</au><au>ZHAOPING LI</au><au>BARACK, Bruce M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does a Clinical Decision Rule Using D-Dimer Level Improve the Yield of Pulmonary CT Angiography?</atitle><jtitle>American journal of roentgenology (1976)</jtitle><addtitle>AJR Am J Roentgenol</addtitle><date>2011-05-01</date><risdate>2011</risdate><volume>196</volume><issue>5</issue><spage>1059</spage><epage>1064</epage><pages>1059-1064</pages><issn>0361-803X</issn><eissn>1546-3141</eissn><coden>AAJRDX</coden><abstract>The objective of our study was to evaluate the impact of incorporating a mandatory clinical decision rule and selective d-dimer use on the yield of pulmonary CT angiography (CTA).
Guidelines incorporating a clinical decision rule (Wells score: range, 0-12.5) and a highly sensitive d-dimer assay as decision points were placed into a computerized order entry menu. From December 2006 through November 2008, 261 pulmonary CTA examinations of 238 men and 14 women (mean age ± SD, 65 ± 12 years; range, 31-92 years) were performed. Eight patients underwent more than one pulmonary CTA examination. Charts were reviewed. The results of pulmonary CTA, the clinical decision rule, and d-dimer level (if obtained) were analyzed with the Student t test, chi-square test, or other comparisons using statistical software (MedCalc, version 11.0).
Of the pulmonary CTA examinations, 16.5% (43/261) were positive for pulmonary embolism (PE) compared with 3.1% (6/196) during the previous 2 years. The mean clinical decision rule score and mean d-dimer level were 5.5 ± 2.4 (SD) and 4956 ± 2892 ng/mL, respectively, for those with PE compared with 4.5 ± 2.1 and 2398 ± 2100 ng/mL for those without PE (both, p < 0.01). The negative predictive value of a clinical decision rule score of 4 or less and d-dimer level of less than 1000 ng/mL was 1.0. A clinical decision rule of greater than 4 and a higher d-dimer level were better predictors for PE, especially a d-dimer level of greater than 3000 ng/mL (odds ratio = 6.69; 95% CI = 2.72-16.43).
Guidelines combining a clinical decision rule with d-dimer level significantly improved the utilization of pulmonary CTA and positive yield for PE.</abstract><cop>Reston, VA</cop><pub>American Roentgen Ray Society</pub><pmid>21512071</pmid><doi>10.2214/AJR.10.4200</doi><tpages>6</tpages></addata></record> |
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| source | American Roentgen Ray Society; MEDLINE; Alma/SFX Local Collection |
| subjects | Aged Angiography - utilization Biological and medical sciences Cardiovascular system Clinical Protocols Cohort Studies Decision Support Techniques Female Fibrin Fibrinogen Degradation Products - metabolism Guideline Adherence Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Patient Selection Pneumology Predictive Value of Tests Pulmonary Embolism - blood Pulmonary Embolism - diagnosis Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Radiodiagnosis. Nmr imagery. Nmr spectrometry Retrospective Studies Tomography, X-Ray Computed - utilization |
| title | Does a Clinical Decision Rule Using D-Dimer Level Improve the Yield of Pulmonary CT Angiography? |
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