Diagnostic prediction models for suspected pulmonary embolism: systematic review and independent external validation in primary care

BMJ : British Medical Journal
Janneke M T HendriksenKarel G M Moons

Abstract

To validate all diagnostic prediction models for ruling out pulmonary embolism that are easily applicable in primary care. Systematic review followed by independent external validation study to assess transportability of retrieved models to primary care medicine. 300 general practices in the Netherlands. Individual patient dataset of 598 patients with suspected acute pulmonary embolism in primary care. Discriminative ability of all models retrieved by systematic literature search, assessed by calculation and comparison of C statistics. After stratification into groups with high and low probability of pulmonary embolism according to pre-specified model cut-offs combined with qualitative D-dimer test, sensitivity, specificity, efficiency (overall proportion of patients with low probability of pulmonary embolism), and failure rate (proportion of pulmonary embolism cases in group of patients with low probability) were calculated for all models. Ten published prediction models for the diagnosis of pulmonary embolism were found. Five of these models could be validated in the primary care dataset: the original Wells, modified Wells, simplified Wells, revised Geneva, and simplified revised Geneva models. Discriminative ability was comp...Continue Reading

Citations

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