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疑似肺栓塞的简化诊断管理 (YEARS研究):一个前性的多中心队列研究
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
概括
在所有年龄组中,YEARS诊断规则安全地排除了肺栓塞 (PE),使计算机断层扫描肺血管扫描 (CTPA) 减少了14%. 这简化了PE诊断,提高了效率.
科学领域:
- 心脏病学
- 肺部医学
- 诊断成像
背景情况:
- 已验证的肺栓塞 (PE) 诊断算法未得到充分利用或仅对特定患者群体有益,导致过度使用计算机断层扫描肺血管学 (CTPA).
- YEARS临床决策规则提供了一种简化的方法,具有差异性的D-二次离子切断,以减少所有年龄段的CTPA检查.
研究的目的:
- 对疑似急性肺栓塞的YEARS诊断算法的有效性和安全性进行前性评估.
主要方法:
- 一项前性多中心队列研究,涉及3465名疑似PE患者.
- 同时评估YEARS规则 (三个项目) 和D-二次元度.
- 如果没有YEARS项目和D-度<1000 ng/mL,或一个+YEARS项目和D-度<500 ng/mL,则不包括PE;其他接受CTPA.
主要成果:
- 在2946名患者中 (85%) 排除了PE,其中18名 (0. 61%) 在3个月内发生了静脉血栓塞,其中6人死亡 (0. 20%).
- 使用YEARS算法的1651名患者 (48%) 避免了CTPA,而使用威尔斯规则的1174名患者 (34%) 避免了CTPA (14%的绝对差异).
结论:
- 在怀疑PE的患者中,YEARS诊断算法安全地排除了肺栓塞.
- 在所有年龄组和子组中,YEARS算法显著减少了14%的CTPA利用率,提高了诊断效率.
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