Wells Rule and d-Dimer Testing to Rule Out Pulmonary Embolism

@article{vanEs2016WellsRA,
  title={Wells Rule and d-Dimer Testing to Rule Out Pulmonary Embolism},
  author={Nick van Es and Tom van der Hulle and Josien van Es and Paul L. den Exter and Ren{\'e}e A. Douma and Robbert J Goekoop and Inge C M Mos and Javier Galipienzo and Pieter Willem Kamphuisen and Menno V. Huisman and Frederikus A. Klok and Harry Bller and Patrick M. M. Bossuyt},
  journal={Annals of Internal Medicine},
  year={2016},
  volume={165},
  pages={253-261}
}
The diagnosis of pulmonary embolism (PE) cannot be based on clinical features alone because the signs and symptoms of PE are not specific (1). Objective imaging tests, including computed tomography pulmonary angiography (CTPA), are therefore warranted to confirm or refute the presence of PE (2). Only 15% to 25% of presenting patients have PE (3), so CTPA is not an appropriate first-line test because of radiation exposure, costs, and risk for contrast-induced nephropathy. To guide decisions… Expand
Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability.
TLDR
A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up. Expand
New evidence in diagnosis of pulmonary embolism during pregnancy
TLDR
D-dimer testing might be useful to avoid radiation imaging in pregnant women considered at low risk for PE when clinicians estimate that PE is the most likely diagnosis. Expand
Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study
TLDR
Pulmonary embolism was safely excluded by the YEARS diagnostic algorithm in patients with suspected pulmonary emblism, and the main advantage of the YEARs algorithm in the authors' patients is the absolute 14% decrease of CTPA examinations in all ages and across several relevant subgroups. Expand
Diagnosis of suspected venous thromboembolism.
  • C. Kearon
  • Medicine
  • Hematology. American Society of Hematology. Education Program
  • 2016
TLDR
Diagnostic testing for venous thromboembolism is to identify all patients who could benefit from anticoagulant therapy and exclude deep vein thrombosis (DVT) or pulmonary embolism (PE). Expand
Combination of Pulmonary Embolism Rule-out Criteria and YEARS Algorithm in a European Cohort of Patients with Suspected Pulmonary Embolism.
TLDR
Combining YEARS with PERC would have yielded only a modest improvement of efficiency in patients without a YEARS item and an unacceptable failure rate in patients with ≥ 1 YEARs item. Expand
Use of clinical prediction rules and D-dimer tests in the diagnostic management of pregnant patients with suspected acute pulmonary embolism.
TLDR
This systematic review aimed to summarize current evidence on the safety and efficacy of clinical decision rules and biomarkers used in the diagnostic management of suspected acute PE in pregnant patients. Expand
Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19—A Prospective Cohort Study
TLDR
The results underline the applicability of YEARS in (suspected) COVID-19 patients with suspected PE and reflect the high thrombotic risk in these patients, warranting ongoing vigilance. Expand
Routine screening for pulmonary embolism in COVID-19 patients at the emergency department: impact of D-dimer testing followed by CTPA
TLDR
By applying this screening algorithm, PE was identified in a considerable proportion of COVID-19 patients, and Prospective management studies should assess if this algorithm safely rules-out PE if D-dimer is < 1.00 mg/L. Expand
Advances in the Diagnosis of Venous Thromboembolism: A Literature Review
TLDR
Development of pulmonary embolism rule-out criteria (PERC) and update in pre-test probability have changed the paradigm of ruling-out patient with low index of suspicion and the D-dimer test in conjunction to the pre- test probability has been utilized in VTE diagnosis. Expand
Simplified and original Wells rules plus age-adjusted D-dimer test were useful for ruling out suspected PE
  • A. Gallus
  • Medicine
  • Annals of Internal Medicine
  • 2017
TLDR
In patients with suspected pulmonary embolism (PE), the simplified and original Wells rules, combined with age-adjusted D-dimer testing, were similarly safe and useful for ruling out PE. Expand
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 53 REFERENCES
Clinically suspected acute recurrent pulmonary embolism: a diagnostic challenge.
TLDR
This prospective study demonstrates the safety of ruling out a clinical suspicion of acute recurrent PE by a simple diagnostic algorithm in patients with a history of PE. Expand
Performance of 4 Clinical Decision Rules in the Diagnostic Management of Acute Pulmonary Embolism
TLDR
All 4 CDRs show similar performance for exclusion of acute PE in combination with a normal d-dimer result, and prospective validation indicates that the simplified scores may be used in clinical practice. Expand
Optimization of the diagnostic management of clinically suspected pulmonary embolism in hospitalized patients
TLDR
It is recommended that the standard diagnostic algorithm for suspected pulmonary embolism should continue to be applied, despite the increase of the failure rate with very small improvements of the efficiency. Expand
Prospective study of the diagnostic accuracy of the simplify D-dimer assay for pulmonary embolism in emergency department patients.
TLDR
The Simplify D-dimer assay had moderate sensitivity and relatively high specificity for PE in low-risk, symptomatic emergency department (ED) patients and the combination of a physician's unstructured estimate of pretest probability of PE of < 15% and a negative d-Dimer result produced a posttest probability ofPE of 0.7%. Expand
Simple and safe exclusion of pulmonary embolism in outpatients using quantitative D-dimer and Wells' simplified decision rule.
TLDR
This study prospectively established the safety of a combination of a dichotomized clinical decision rule and D-dimer test in ruling out PE, and proved highly efficient, since more than 50% of patients could be managed without the need for more invasive and expensive tests. Expand
Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study.
TLDR
The combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. Expand
Use of a Clinical Model for Safe Management of Patients with Suspected Pulmonary Embolism
TLDR
The optimal strategy for investigating patients with suspected pulmonary embolism should combine clinical assessment, ventilation-perfusion scanning, and venous ultrasonography of the lower extremities, and the group developed a useful clinical model by reviewing the literature and coming to a consensus on a scoring system. Expand
Clinical decision rule and D-dimer have lower clinical utility to exclude pulmonary embolism in cancer patients. Explanations and potential ameliorations.
TLDR
The Wells CDR and D-dimer perform less well in patients with suspected PE if they have cancer, and a CDR combined with an age-dependent D- dimer cut-off shows a modest improvement of the strategy in cancer patients. Expand
Effectiveness of a diagnostic algorithm combining clinical probability, D-dimer testing, and computed tomography in patients with suspected pulmonary embolism in an emergency department.
TLDR
The effectiveness of a diagnostic management strategy using a simple clinical decision rule, D-dimer testing, and CT in the evaluation and management of patients with clinically suspected pulmonary embolism is confirmed. Expand
Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism.
TLDR
In patients with suspected PE and previous VTE, a negative D-dimer test result seems to allow safely ruling out a recurrent event, however, the proportion of negative results is lower in such patients, definitely reducing the clinical usefulness of the D- dimer test in that subgroup. Expand
...
1
2
3
4
5
...