肺栓塞风险分层:对四级临床预测概率评分 (4PEPS) 的外部验证
Philip Chiang1, Helia Robert-Ebadi2, Arnaud Perrier3
1Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Ontario, Canada.
Research and practice in thrombosis and haemostasis
|March 6, 2024
概括
肺栓塞 (PE) 的四级临床预测概率得分 (4PEPS) 在外部验证中显示出1.2%的失败率. 风险非常低的组比预期的更高的PE流行率,需要在临床使用前进行进一步研究.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 诊断的准确性 诊断的准确性
背景情况:
- 肺栓塞 (PE) 诊断依赖于临床决策规则.
- 4级临床预试验概率得分 (4PEPS) 将患者分为不同风险类别.
- 这些类别指导诊断测试,从D-二次体到成像.
研究的目的:
- 为了外部验证4PEPS模型的诊断性能.
- 评估4PEPS在现实世界急诊室环境中的安全性和准确性.
主要方法:
- 4PEPS被应用于756名疑似PE患者的前性数据库.
- 用4PEPS确定了患者的风险类别 (非常低,低,中等,高).
- 失败率是根据PE诊断计算的,这些患者被评估为低风险或非常低风险.
主要成果:
- 4PEPS的整体失败率为1.2% (95% CI,0.59%-2.23%),尽管有负面规则,但在734名患者中,有9人被诊断为PE.
- 在极低风险组中,PE患病率为5.6%,高于预期.
- 低风险的患病率为9.4%,中等风险为50%,高风险为86%.
结论:
- 4PEPS的整体失败率很低,但在高流行率的环境中需要谨慎.
- 在极低风险组中,比预期更高的PE患病率需要进一步调查.
- 在常规实施4PEPS之前,建议进行前性验证.
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