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Pre-test Probability Scores D-Dimer and Ultrasonography in the Diagnosis of Pulmonary Thromboembolism

Author: ChenHuiZuo
Tutor: HuXiaoZuo
School: Shanxi Medical
Course: Department of Respiratory Medicine
Keywords: Pulmonary thromboembolism Clinical score D-Dimer Comprehensive ultrasound
CLC: R563.5
Type: Master's thesis
Year: 2008
Downloads: 112
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Abstract


Objective To evaluate the clinical symptom score, D-dimer (D-Dimer) and ultrasound (lower extremity deep venous ultrasound echocardiography) individually check and their joint trial of suspected pulmonary thromboembolic disease (pulmonarythromboembolism, PTE) of the patient's diagnosis and Exclude diagnostic significance. Methods 139 cases diagnosed PTE patients as a diagnostic group, 50 cases of suspected admission excluded by examination of PTE patients as a control group, clinical symptom score for each patient, and record the D-Dimer of deep venous ultrasound, echocardiography results. By drawing the curve of the receiver operating characteristic (ROC) curve was evaluated both clinical symptoms score and quantitative Latex law detection D-Dimer PTE diagnostic performance; calculate the four single experiment and series after the epidemic markers, evaluation of patients with suspected PTE diagnosis and to exclude diagnostic significance. Result, the area under the ROC curve (1) Wells scoring AUC = 0.692 (95% CI, 0.610 to 0.775), Geneva rated AUC = 0.709 (95% CI, 0.633 to 0.786), both showed no significant difference (P> 0.05). When Wells score> 7.5, Geneva score> 10 timeshare PTE have confirmed; (2) The area under the ROC curve quantitative Latex assay D-Dimer was 0.775 (95% CI ,0.668-0 .881) of PTE in single degree of diagnostic performance; (3) Wells score, Geneva score highly likely the high specificity of the diagnosis of PTE, respectively, 92% and 100%; poor sensitivity of 22.6% and 22.3%, respectively; (4) test of deep venous ultrasound Youden index was 0.615, suggestive of the diagnosis of PTE; (5) for the diagnosis and control groups in all patients using the Latex method of semi-quantitative or quantitative Latex law detection of D-Dimer negative likelihood ratio 0.3 (0.1), use quantitative the Latex law negative likelihood ratio was 0.453 (> 0.1); diagnostic group and the control group in Geneva score low, moderate, likely in patients using semi-quantitative of Latex law or quantitative Latex assay D -Dimer, negative likelihood ratio of 0.261 (> 0.1), use quantitative the Latex law negative likelihood ratio was 0.552 (> 0.1). That these two methods to detect negative D-Dimer can not exclude the diagnosis of acute PTE; (6) number and series test could improve the sensitivity and specificity of the diagnosis of PTE; highest Youden index (7) parallel test Geneva score height may lower extremity deep venous ultrasound, was 0.636 (sensitivity 85.6%, specificity 78.0%), positive likelihood ratio of 3.891. Highest Youden index series test of deep venous ultrasound echocardiography 0.614 (sensitivity 73.4%, specificity 88.0%), positive likelihood ratio 6.120; (8) The number of parallel test negative likelihood ratio <0.1, PTE exclude diagnostic significance; (9) all series test positive likelihood ratio was less than 10, the negative likelihood ratio> 0.1 PTE diagnosis and exclude diagnostic significance. Geneva score more objective, accurate, highly probable PTE have confirmed conclusions; Latex assay negative D-Dimer quantitative or semi-quantitative alone can not exclude the diagnosis of acute PTE, recommend the use of the parallel test to exclude; joint in patients with clinical manifestations, D-Dimer measurement and the results of the ultrasound suspected PTE high sensitivity, up to 90% or even 100%; for grassroots hospitals do not have the PTE diagnosis equipment, we recommend the Geneva score and lower extremity deep venous ultrasound as a suspect diagnosis of PTE key projects.

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CLC: > Medicine, health > Internal Medicine > Respiratory system and chest diseases > Pulmonary disease > Pulmonary embolism
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