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dc.contributor.authorAkhter, Murtaza
dc.contributor.authorKline, Jeffrey
dc.contributor.authorBhattarai, Bikash
dc.contributor.authorCourtney, Mark
dc.contributor.authorKabrhel, Christopher
dc.date.accessioned2018-08-07T22:42:40Z
dc.date.available2018-08-07T22:42:40Z
dc.date.issued2018-05
dc.identifier.citationAkhter, M., Kline, J., Bhattarai, B., Courtney, M., & Kabrhel, C. (2018). Ruling out Pulmonary Embolism in Patients with High Pretest Probability. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 19(3). http://dx.doi.org/10.5811/westjem.2017.10.36219en_US
dc.identifier.issn19369018
dc.identifier.pmid29760845
dc.identifier.doi10.5811/westjem.2017.10.36219
dc.identifier.urihttp://hdl.handle.net/10150/628362
dc.description.abstractIntroduction: The American College of Emergency Physicians guidelines recommend more aggressive workup beyond imaging alone in patients with a high pretest probability (PTP) of pulmonary embolism (PE). However, the ability of multiple tests to safely rule out PE in high PTP patients is not known. We sought to measure the ability of negative computed tomography pulmonary angiography (CTPA) along with negative D-dimer to rule out PE in these high-risk patients. Methods: We analyzed data from a previous prospective observational study conducted in 12 emergency departments (ED). Wells score criteria were entered by providers before final PE testing. PE was diagnosed by imaging on the index ED visit, or within 45 days, demonstrating either PE or deep vein thrombosis (DVT), or if the patient died of PE during the 45-day, follow-up period. Testing threshold was set at 1.8%. Results: A total of 7,940 patients were enrolled and tested for PE, and 257 had high PTP (Wells > 6). Sixteen of these high-risk patients had negative CTPA and negative D-dimer, of whom two were positive for PE (12.5% [95% confidence interval {2.2%-40.0%}]). One of these patients had a DVT on CT venogram and the other was diagnosed at follow-up. Conclusion: Our analysis suggests that in patients with high PTP of PE, neither negative CTPA by itself nor a negative CTPA plus a negative D-dimer are sufficient to rule out PE. More aggressive workup strategies may be required for these patients.en_US
dc.description.sponsorshipEmergency Medicine Foundation; National Institutes of Health; Diagnostica Stago; Siemens Healthcare; Janssen; Roche; Pfizer; Massachusetts General Hospitalen_US
dc.language.isoenen_US
dc.publisherWESTJEMen_US
dc.relation.urlhttps://escholarship.org/uc/item/74h4h8qben_US
dc.rightsCopyright: © 2018 Akhter et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License.en_US
dc.titleRuling out Pulmonary Embolism in Patients with High Pretest Probabilityen_US
dc.typeArticleen_US
dc.contributor.departmentUniv Arizona, Coll Med Phoenix, Maricopa Integrated Hlth Syst, Dept Emergency Meden_US
dc.contributor.departmentUniv Arizona, Coll Med Phoenix, Maricopa Integrated Hlth Syst, Dept Med Admen_US
dc.identifier.journalWESTERN JOURNAL OF EMERGENCY MEDICINEen_US
dc.description.noteOpen access journal.en_US
dc.description.collectioninformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.en_US
dc.eprint.versionFinal published versionen_US
dc.source.journaltitleWestern Journal of Emergency Medicine
dc.source.volume19
dc.source.issue3
dc.source.beginpage487
dc.source.endpage493
refterms.dateFOA2018-08-07T22:42:40Z


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