肺栓塞の排除基準が,低リスクの救急治療室の患者に与える影響:PROPERランダム化臨床試験
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PubMedで要約を見る
まとめ
この要約は機械生成です。肺栓塞排除基準 (PERC) 戦略は,非常に低リスクの患者で肺栓塞 (PE) を排除するのに安全です. このランダム化試験では,従来の治療と比較して,血栓塞栓症のリスクが増加しなかった.
科学分野
- 緊急 医療
- 心臓病科
- 臨床試験
背景
- 肺栓塞 (PE) の診断のための肺栓塞排除基準 (PERC) 戦略の安全性は,ランダム化臨床試験によって確立されていません.
- PERCは8項目の臨床ガイドラインで,臨床的確率が低い患者でPEを排除するために使用されます.
研究 の 目的
- PEを排除するためのPERCベースの戦略の安全性と有効性を将来的に検証する.
- PERC戦略と従来の診断方法の間の血栓塞栓事件の割合を比較する.
主な方法
- 14のフランスの緊急部でクロスオーバー・クラスターランダム化非劣等性試験が行われました.
- PEの臨床的確率が低い患者は,PERCによる戦略または従来の治療にランダムに割り当てられました.
- 主要評価項は3ヶ月以内に診断されていない血栓塞栓症の発生率で,非劣等性の差は1. 5%でした.
主要な成果
- PERC群 (1. 5%) と対照群 (2. 7%) の間で,初期プレゼンテーション (P=0. 052) で,血栓塞栓事件の発生率に有意な差は認められなかった.
- PERC群では追跡期間中に単一の血栓塞栓が発生し,対照群では発生しなかった (0. 1%).
- PERC戦略により,計算機断層肺動脈造影 (CTPA) の使用が10%減少し,緊急治療室の滞在時間が36分短縮され,入院率が3.3%減少しました.
結論
- PERCベースの戦略は,非常に低リスクの患者でPEを排除するために従来のケアに劣らない.
- PERC戦略の実施は 診断検査と医療資源の利用を 非常事態室で安全に減らすことができます
- これらの発見は,PEの疑いのある選択された低リスクの患者にPERCの日常的な使用を支持する.
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