Clinical studyComparison of two clinical prediction rules and implicit assessment among patients with suspected pulmonary embolism☆
Section snippets
Patients
Consecutive patients admitted to the emergency departments of three teaching hospitals in Geneva and Lausanne, Switzerland, and Angers, France, for suspected pulmonary embolism were included in a prospective study of a diagnostic algorithm that included helical computed tomography (CT). We studied the first 390 patients enrolled in that study (from October 31, 2000, to April 1, 2001): 200 (51%) were from Geneva, 107 (27%) were from Lausanne, and 83 (21%) were from Angers. We excluded 113
Results
Most patients presented with chest pain or dyspnea (Table 2). Nine patients died during the 3-month follow-up; none from pulmonary embolism. Pulmonary embolism was diagnosed in 71 patients (26%) according to the study criteria (Table 3). Among the patients initially classified as not having pulmonary embolism, 2 were re-evaluated during the follow-up because of symptoms of venous thromboembolism. A deep vein thrombosis was confirmed in 1 patient by a positive ultrasonography, and a pulmonary
Discussion
We found that two recently published prediction rules for pulmonary embolism 13, 14 performed equally well in a sample of consecutive emergency department patients from three teaching hospitals. Furthermore, our results suggest that the Geneva rule performs better when complemented with implicit clinical judgment. The accuracy of the prediction rules was equivalent, but not superior, to that of implicit clinical judgment in the landmark PIOPED study (8) and several other series 9, 10.
This
Acknowledgements
We are indebted to all the internal medicine residents rotating in the emergency department for their help throughout the study and to Dominique Gillis, MD, for her help in collecting the data in Lausanne.
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This study was supported by grant 00/4-T9 from the Royal College of Physicians and Surgeons, Canada; a grant from La Fondation Québécoise pour le Progrès de la Médecine Interne and Les Internistes et Rhumatologues Associés de l’Hôpital du Sacré-Cœur, Montréal, Canada; and grant 32-61773.00 from the Swiss National Science Foundation, Bern, Switzerland.