这个病人有肺栓塞吗?
Sanjeev D Chunilal1, John W Eikelboom, John Attia
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
JAMA
|December 6, 2003
概括
临床预测规则和经验丰富的临床医生的gestalt准确地评估肺栓塞预测概率. 预测规则被推用于较少经验的医疗保健专业人员的更广泛使用.
科学领域:
- 肺部医学 肺部医学
- 诊断的准确性 诊断的准确性
- 临床决策 临床决策
背景情况:
- 经验丰富的临床医生在估计肺栓塞预测概率时使用gestalt辅助.
- 临床预测规则与gestalt对于此评估的可比性尚不清楚.
- 临床预测规则可以赋予经验较少的专业人员在诊断肺栓塞方面的能力.
研究的目的:
- 为了比较临床gestalt与CPR在评估肺栓塞的预测概率方面的准确性.
- 评估CPR在简化PE诊断方面的实用性.
主要方法:
- 进行了对MEDLINE (1966-2003) 和文献资料的系统文献搜索.
- 研究包括连续的,未经选择的患者,医生对诊断测试结果视而不见.
- 涉及8306名患者的16项研究符合最终分析的纳入标准.
主要成果:
- 临床手术显示PE率为8-19% (低),26-47% (中等) 和46-91% (高) 的概率.
- CPR显示PE率为3-28% (低),16-46% (中等) 和38-98% (高) 的概率.
- 这两种方法在区分PE风险类别方面都显示出相似的准确性.
结论:
- 临床gestalt和CPR在按PE预试验概率对患者进行分层方面表现出可比的准确性.
- 由于其已被证明的准确性和适用性,CPR被不同经验水平的临床医生所倡导.
- 低预测概率 (通过CPR) 和负的D-二分体试验的组合可靠地排除PE.
相关概念视频
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:30Venous Thrombosis IV: Nursing Management
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
01:29Pulmonary Embolism I: Introduction
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
01:27Pulmonary Embolism III: Nursing Management
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
01:19Pulmonary Embolism I: Introduction
A blood clot, or thrombus, is a semi-solid mass composed of fibrin, platelets, and red blood cells. When it forms within a vessel, it can obstruct blood flow, known as thrombosis. If part of the clot detaches, it becomes an embolus that can travel and block distant vessels. When this occurs in the pulmonary arteries, it causes a condition known as pulmonary embolism (PE).Origin and ImpactMost often, the embolus originates from a thrombus in the deep veins of the lower limbs, a condition called...