Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism
Rattachement africain : nl, ie, fr, us, gr. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Pulmonary embolism is one of the leading causes of maternal death in the Western world. Because of the low specificity and sensitivity of the d-dimer test, all pregnant women with suspected pulmonary embolism undergo computed tomographic (CT) pulmonary angiography or ventilation-perfusion scanning, both of which involve radiation exposure to the mother and fetus. Whether a pregnancy-adapted algorithm could be used to safely avoid diagnostic imaging in pregnant women with suspected pulmonary embolism is unknown. METHODS: In a prospective study involving pregnant women with suspected pulmonary embolism, we assessed three criteria from the YEARS algorithm (clinical signs of deep-vein thrombosis, hemoptysis, and pulmonary embolism as the most likely diagnosis) and measured the d-dimer level. Pulmonary embolism was ruled out if none of the three criteria were met and the d-dimer level was less than 1000 ng per milliliter or if one or more of the three criteria were met and the d-dimer level was less than 500 ng per milliliter. Adaptation of the YEARS algorithm for pregnant women involved compression ultrasonography for women with symptoms of deep-vein thrombosis; if the results were positive (i.e., a clot was present), CT pulmonary angiography was not performed. All patients in whom pulmonary embolism had not been ruled out underwent CT pulmonary angiography. The primary outcome was the incidence of venous thromboembolism at 3 months. The secondary outcome was the proportion of patients in whom CT pulmonary angiography was not indicated to safely rule out pulmonary embolism. RESULTS: A total of 510 women were screened, of whom 12 (2.4%) were excluded. Pulmonary embolism was diagnosed in 20 patients (4.0%) at baseline. During follow-up, popliteal deep-vein thrombosis was diagnosed in 1 patient (0.21%; 95% confidence interval [CI], 0.04 to 1.2); no patient had pulmonary embolism. CT pulmonary angiography was not indicated, and thus was avoided, in 195 patients (39%; 95% CI, 35 to 44). The efficiency of the algorithm was highest during the first trimester of pregnancy and lowest during the third trimester; CT pulmonary angiography was avoided in 65% of patients who began the study in the first trimester and in 32% who began the study in the third trimester. CONCLUSIONS: Pulmonary embolism was safely ruled out by the pregnancy-adapted YEARS diagnostic algorithm across all trimesters of pregnancy. CT pulmonary angiography was avoided in 32 to 65% of patients. (Funded by Leiden University Medical Center and 17 other participating hospitals; Artemis Netherlands Trial Register number, NL5726.).
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism
- Date Crossref
- 21/03/2019
- Éditeur
- Massachusetts Medical Society
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
-
Leiden University Medical Center From the Department of Thrombosis and Hemostasis pays non établi dans la noticeOrganisme public
-
Haga Hospital pays non établi dans la noticeÉtablissement de santé
-
De Kinderkliniek pays non établi dans la noticeÉtablissement de santé
-
Amsterdam University Medical Centers Department of Vascular Medicine pays non établi dans la noticeÉtablissement de santé
-
Amsterdam Cardiovascular Sciences pays non établi dans la noticeOrganisme public
-
University of Amsterdam pays non établi dans la noticeUniversité ou école supérieure
-
Rotunda Hospital Department of Haematology pays non établi dans la noticeÉtablissement de santé
-
Gelre Hospitals Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
-
Inserm pays non établi dans la noticeOrganisme public
-
Université Jean Monnet Equipe Dysfonction Vasculaire et Hémostase pays non établi dans la noticeUniversité ou école supérieure
-
Groene Hart Ziekenhuis pays non établi dans la noticeÉtablissement de santé
-
Lourdes Hospital pays non établi dans la noticeÉtablissement de santé
From the Department of Thrombosis and Hemostasis — Leiden University Medical Center, Haga Hospital et De Kinderkliniek, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.