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Clinical probability scoring and pulmonary embolism
  1. Ged Brown, Specialist Registrar,
  2. Kerstin Hogg, Clinical Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones:man.ac.uk

    Abstract

    A short cut review was carried out to establish the diagnostic utility of clinical probability scoring in stratifying the risk of pulmonary embolus. A total of 938 papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Ged Brown,Specialist RegistrarChecked by Kerstin Hogg, Clinical Research Fellow

    Clinical scenario

    A 30 year old man presents to the department with a spontaneous onset of atraumatic pleuritic chest pain. He has no previous medical history and has no shortness of breath or haemodynamic compromise. You wonder whether his clinical features and risk factors can help to safely exclude a pulmonary embolus.

    Three part question

    In [a patient presenting with features suggestive of pulmonary embolus] what is [the diagnostic utility of clinical probability scoring] in [stratifying risk of pulmonary embolus]?

    Search strategy

    Medline 1966–04/03 using the OVID interface. (exp Pulmonary Embolism OR exp Thromboembolism OR PE.mp OR pulmonary infarct$.mp OR Pulmonary Embol$.mp) AND (exp Risk Assessment OR risk assessment.mp OR risk stratification.mp OR probability.mp) LIMIT to human AND English language.

    Search outcome

    Altogether 938 papers were found of which 935 papers were irrelevant to the question, of insufficient quality or did not report a mathematically derived scoring systems. The remaining three are included in table 6.

    Table 6

    NB The clinical scoring systems have not been represented in the table. Please refer to the individual papers for these details.

    Comments

    There is evidence to suggest a variety of clinical models can be used to stratify patients into different levels of risk for PE. It is possible that these may be combined with other tests to give an acceptably low post-test probability of PE.

    CLINICAL BOTTOM LINE

    Clinical risk stratification is a potentially useful method of identifying low risk patients in whom PE may be safely excluded by simple non-invasive tests.

    Report by Ged Brown,Specialist RegistrarChecked by Kerstin Hogg, Clinical Research Fellow

    References

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