Safety of the Combination of PERC and YEARS Rules in Patients With Low Clinical Probability of Pulmonary Embolism: A Retrospective Analysis of Two Large European Cohorts.
In: Academic Emergency Medicine, Jg. 26 (2019), Heft 1, S. 23-30
Online
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Zugriff:
Background: This study aimed to determine the failure rate of a combination of the PERC and the YEARS rules for the diagnosis of pulmonary embolism (PE) in the emergency department (ED). Methods: We performed a retrospective analysis of two European cohorts of emergency patients with low gestalt clinical probability of PE (PROPER and PERCEPIC). All patients we included were managed using a conventional strategy (D‐dimer test, followed, if positive, by computed tomographic pulmonary angiogram (CTPA). We tested a diagnostic strategy that combined PERC and YEARS to rule out PE. The primary endpoint was a thromboembolic event diagnosed in the ED or at 3‐months follow‐up. Secondary endpoints included a thromboembolic event at baseline in the ED and a CTPA in the ED. Ninety‐five percent confidence intervals (CIs) of proportions were calculated with the use of Wilson's continuity correction. Results: We analyzed 1,951 patients (mean ± SD age = 47 ± 18 years, 56% women) with an overall proportion of patients with PE of 3.5%. Both PERC and YEARS strategies were associated with 11 missed PE in the ED: failure rate 0.57 (95% CI = 0.32–1.02). At 3‐month follow‐up, the overall failure rate was 0.83% (95% CI = 0.51–1.35). Among the 503 patients who underwent a CTPA (26%), the use of the PERC–YEARS combination would have ruled out PE without CTPA in 249 patients (50% [95%CI = 45%–54%], absolute reduction 13% (95% CI = 11%–14%]). Conclusion: The combination of PERC then YEARS was associated with a low risk of PE diagnostic failure and would have resulted in a relative reduction of almost half of CTPA. [ABSTRACT FROM AUTHOR]
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Titel: |
Safety of the Combination of PERC and YEARS Rules in Patients With Low Clinical Probability of Pulmonary Embolism: A Retrospective Analysis of Two Large European Cohorts.
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Autor/in / Beteiligte Person: | Gorlicki, Judith ; Penaloza, Andrea ; Germeau, Boris ; Moumneh, Thomas ; Philippon, Anne‐Laure ; Truchot, Jennifer ; Douillet, Delphine ; Steinier, Charlotte ; Soulié, Caroline ; Bloom, Ben ; Cachanado, Marine ; Roy, Pierre‐Marie ; Freund, Yonathan ; Zehtabchi, Shahriar |
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Zeitschrift: | Academic Emergency Medicine, Jg. 26 (2019), Heft 1, S. 23-30 |
Veröffentlichung: | 2019 |
Medientyp: | academicJournal |
ISSN: | 1069-6563 (print) |
DOI: | 10.1111/acem.13508 |
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