Format

Send to

Choose Destination
See comment in PubMed Commons below
Am J Respir Crit Care Med. 2008 Aug 1;178(3):290-4. doi: 10.1164/rccm.200802-207OC. Epub 2008 Apr 24.

Simple and accurate prediction of the clinical probability of pulmonary embolism.

Author information

1
Dipartimento di Area Critica Medico Chirurgica, Università di Firenze, Viale Morgagni 85, 50134 Firenze, Italy. massimo.miniati@unifi.it

Abstract

RATIONALE:

Clinical probability assessment is a fundamental step in the diagnosis of pulmonary embolism.

OBJECTIVES:

To develop a predictive model for pulmonary embolism based on clinical symptoms, signs, and the interpretation of the electrocardiogram.

METHODS:

The model was developed from a database of 1,100 patients with suspected pulmonary embolism, of whom 440 had the disease confirmed by angiography or autopsy findings. It was validated in an independent sample of 400 patients with suspected pulmonary embolism (71% were inpatients). Easy-to-use software was developed for computing the clinical probability on palm computers and mobile phones.

MEASUREMENTS AND MAIN RESULTS:

The model comprises 16 variables of which 10 (older age, male sex, prolonged immobilization, history of deep vein thrombosis, sudden-onset dyspnea, chest pain, syncope, hemoptysis, unilateral leg swelling, electrocardiographic signs of acute cor pulmonale) are positively associated, and 6 (prior cardiovascular or pulmonary disease, orthopnea, high fever, wheezes, or crackles on chest auscultation) are negatively associated with pulmonary embolism. In the validation sample, 165 (41%) of 400 patients had pulmonary embolism confirmed by angiography. The prevalence of pulmonary embolism was 2% when the predicted clinical probability was slight (0 to 10%), 28% when moderate (11 to 50%), 67% when substantial (51 to 80%), and 94% when high (81 to 100%). There was no significant difference between inpatients and outpatients with respect to the prevalence of pulmonary embolism in the four probability categories.

CONCLUSIONS:

The proposed model is simple and accurate, and it may aid physicians when assessing the clinical probability of pulmonary embolism.

PMID:
18436792
DOI:
10.1164/rccm.200802-207OC
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Atypon
    Loading ...
    Support Center