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肺栓塞の疑いに対する簡素化された診断管理 (YEARS研究):前向きな多センターコホート研究
Tom van der Hulle1, Whitney Y Cheung2, Stephanie Kooij3
1Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands.
Lancet (London, England)
|May 28, 2017
まとめ
YEARSの診断ルールは,患者における肺栓塞 (PE) を無事に排除し,すべての年齢層において,コンピュータトモグラフィの肺血管図 (CTPA) のスキャンを14%減少させた. これは PEの診断を簡素化し,効率を向上させます.
科学分野:
- 心臓病科
- 肺医学
- 診断用イメージング
背景:
- 肺栓塞 (PE) の検証済みの診断アルゴリズムは十分に活用されていないか,または特定の患者グループのみが恩恵を受けるため,計算機断層検査肺血管検査 (CTPA) の使用が過度である.
- YEARSの臨床決定ルールは,すべての年齢でCTPAの検査を減らすために,異なるD-ダイマーカットオフを持つ簡素化されたアプローチを提供します.
研究 の 目的:
- 急性肺栓塞 (PE) の疑いに対するYEARS診断アルゴリズムの有効性と安全性を前向きに評価する.
主な方法:
- PEの疑いのある患者3465人を対象とした前向きな多センターコホート研究
- YEARSルールとD-ダイマー濃度の同時評価 (3項目)
- PEは,YEARS項目がない場合とD-ダイマー <1000ng/mL,または1+YEARS項目とD-ダイマー <500ng/mLを除く.その他はCTPAを受けた.
主要な成果:
- PEを排除した2946人の患者 (85%) のうち,18人の患者 (0. 61%) が3ヶ月以内に静脈血栓塞栓症を発症し,そのうち6人の患者 (0. 20%) が死亡しました.
- YEARSアルゴリズムを使用した1651人 (48%) の患者でCTPAは避けられ,ウェルズのルールを使用した1174人 (34%) の患者で (14%の絶対差) であった.
結論:
- YEARSの診断アルゴリズムは,肺栓塞が疑われる患者の肺栓塞を無事に排除します.
- YEARSアルゴリズムは,すべての年齢層とサブグループでCTPAの使用量を14%大幅に削減し,診断効率を向上させます.
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