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Previous Volume 352:1760-1768 April 28, 2005 Number 17 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Goldhaber, S. Z. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Single-detector–row computed tomography (CT) has a low sensitivity for pulmonary embolism and must be combined with venous-compression ultrasonography of the lower limbs. We evaluated whether the use of D-dimer measurement and multidetector-row CT, without lower-limb ultrasonography, might safely rule out pulmonary embolism.

Methods We included 756 consecutive patients with clinically suspected pulmonary embolism from the emergency departments of three teaching hospitals and managed their cases according to a standardized sequential diagnostic strategy. All patients were followed for three months.

Results Pulmonary embolism was detected in 194 of the 756 patients (26 percent). Among the 82 patients with a high clinical probability of pulmonary embolism, multidetector-row CT showed pulmonary embolism in 78, and 1 patient had proximal deep venous thrombosis and a CT scan that was negative for pulmonary embolism. Of the 674 patients without a high probability of pulmonary embolism, 232 (34 percent) had a negative D-dimer assay and an uneventful follow-up; CT showed pulmonary embolism in 109 patients. CT and ultrasonography were negative in 318 patients, of whom 3 had a definite thromboembolic event and 2 died of possible pulmonary embolism during follow-up (three-month risk of thromboembolism, 1.7 percent; 95 percent confidence interval, 0.7 to 3.9). Two patients had proximal deep venous thrombosis and a negative CT scan (risk, 0.6 percent; 95 percent confidence interval, 0.2 to 2.2). The overall three-month risk of thromboembolism in patients without pulmonary embolism would have been 1.5 percent (95 percent confidence interval, 0.8 to 3.0) if the D-dimer assay and multidetector-row CT had been the only tests used to rule out pulmonary embolism and ultrasonography had not been performed.

Conclusions Our data indicate the potential clinical use of a diagnostic strategy for ruling out pulmonary embolism on the basis of D-dimer testing and multidetector-row CT without lower-limb ultrasonography. A larger outcome study is needed before this approach can be adopted.

Source Information

From the Service of General Internal Medicine (A.P.) and the Division of Angiology and Hemostasis (G.L.G., H.B.), Department of Internal Medicine, and the Service of Radiodiagnosis and Interventional Radiology, Department of Medical Radiology and Informatics (N.H.), Geneva Faculty of Medicine and Geneva University Hospital, Geneva; the Emergency Department (P.-M.R.), the Service of Radiology (A.-L.G.), and the Service of Cardiology (A.F.), Angers University Hospital, Angers, France; and the Service of Pneumology (O.S., G.M.), the Service of Radiology (M.-P.R.), and the Emergency Department (A.D.), Hôpital Européen Georges-Pompidou, Paris.

Address reprint requests to Dr. Perrier at the Service of General Internal Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland, or at arnaud.perrier{at}medecine.unige.ch.

Full Text of this Article

Related Letters:

Multidetector-Row Computed Tomography in Suspected Pulmonary Embolism
Turpie A. G.G., Siegel M. D., Perrier A., Roy P.-M., Meyer G., Goldhaber S. Z.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:630-631, Aug 11, 2005. Correspondence

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