Clinical studyA structured clinical model for predicting the probability of pulmonary embolism☆
Section snippets
Sample
The sample consisted of 1100 consecutive patients who were referred to our institution for suspected pulmonary embolism between November 1, 1991, and December 31, 1999, and in whom the disease was diagnosed or excluded. The clinical characteristics of 500 of these patients have been described (8). All patients were examined according to a standardized protocol that included clinical evaluation, perfusion lung scanning, and pulmonary angiography 5, 8.
Clinical evaluation
Upon study entry, patients were examined by
Results
The 1100 patients had a median age of 68 years (range, 15 to 94 years); 498 (45%) of them were male (Table 1). Eighty-one percent (n = 891) were hospitalized at the time of study entry. The median time between onset of symptoms and study entry was 1 day (range, 0 to 30 days). Based on angiography and autopsy data, the prevalence of pulmonary embolism was 40% (n = 440). Among patients without pulmonary embolism, 242 had the diagnosis excluded based on a normal or near-normal perfusion scan.
Discussion
The results of large-scale prospective studies of the diagnosis of pulmonary embolism lend support to the concept that clinical assessment is a fundamental step in the diagnostic work-up of patients 4, 5, 6. Although the diagnostic yield of individual signs, symptoms, and common laboratory tests is limited, the combination of these variables, either by empirical assessment or by a prediction rule, can be used to express the clinical probability of pulmonary embolism.
In a multicenter Canadian
Acknowledgements
The authors wish to thank the following physicians who took part in the study: Renato Prediletto, Bruno Formichi, Giorgio Di Ricco, Carlo Marini, Massimo Pistolesi, Germana Allescia, Lucia Tonelli, Carolina Bauleo, Laura Carrozzi, Giosuè Catapano, Luigi Rizzello, Alba Dainelli, and Elvio Scoscia.
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This work was supported in part by the Ministry of Health and the Ministry of University and Scientific and Technological Research of Italy.