The probability of pulmonary embolism is a function of the diagnoses considered most likely before testing

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
C KabrhelSamuel Z Goldhaber

Abstract

To determine the frequency of pulmonary embolism (PE) diagnosis when different alternative diagnoses were considered most likely before testing, because the relationship between specific alternative diagnoses and the diagnosis of PE has not been explored. This study was a preplanned secondary analysis of a prospective study of the diagnosis of pulmonary embolism conducted in the emergency department (ED) of an urban university hospital. Physicians were queried as to their most likely pretest diagnosis when they ordered any of the following tests to evaluate possible PE: D-dimer, contrast-enhanced computed tomography of the chest, ventilation-perfusion lung scan, or pulmonary angiogram. To compare the frequency of PE diagnosis across alternative diagnoses, risk ratios, 95% confidence intervals (CI), and p-values using Fisher's exact test were calculated. Six hundred seven patients were enrolled, and 61 had PE. Physicians thought PE was the most likely pretest diagnosis in 162 (26.7%) patients, and 20.4% (95% CI = 14.4% to 27.4%) of these patients had PE. For four alternative diagnoses, PE was diagnosed less frequently than when PE was considered most likely: musculoskeletal pain (2.2%, 95% CI = 0.4% to 6.2%), anxiety (1.7%, 95% ...Continue Reading

References

Feb 25, 1999·Archives of Internal Medicine·J G Rajendran, A F Jacobson
Jul 29, 2003·Annals of Emergency Medicine·Jeffrey A Kline, Philip S Wells
Apr 21, 2004·Annals of Internal Medicine·Paul D SteinNeeraj K Kalra
Jun 4, 2004·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Peter B RichmanJeffrey A Kline
Apr 28, 2005·JAMA : the Journal of the American Medical Association·Rene QuirozU Joseph Schoepf
Sep 17, 2005·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jeffrey A KlineWilliam B Webb
Oct 6, 2005·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Christopher KabrhelSamuel Z Goldhaber

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Citations

Jun 13, 2008·Pharmacy World & Science : PWS·Huang-Chi ChenCheng-Yuan Wang
Sep 2, 2008·Journal of Evaluation in Clinical Practice·Mårten SöderbergGerd Lärfars
Apr 13, 2015·The Journal of Emergency Medicine·Jeffrey A Kline, Christopher Kabrhel
Aug 4, 2016·Emergency Medicine Journal : EMJ·Jeffrey A KlineJacob Capito

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