Performance of the 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) in the diagnostic management of pulmonary embolism: An external validation study
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Le résumé fourni par la source
BACKGROUND: The recently published 4-level Pulmonary Embolism Clinical Probability Score (4PEPS) integrates different aspects from currently available diagnostic strategies to further reduce imaging testing in patients with clinically suspected pulmonary embolism (PE). AIM: To externally validate the performance of 4PEPS in an independent cohort. METHODS: In this post-hoc analysis of the prospective diagnostic management YEARS study, the primary outcome measures were discrimination, calibration, efficiency (proportion of imaging tests potentially avoided), and failure rate (venous thromboembolism (VTE) diagnosis at baseline or follow-up in patients with a negative 4PEPS algorithm). Multiple imputation was used for missing 4PEPS items. Based on 4PEPS, PE was considered ruled out in patients with a very low clinical pre-test probability (CPTP) without D-dimer testing, in patients with a low CPTP and D-dimer <1000 μg/L, and in patients with a moderate CPP and D-dimer below the age-adjusted threshold. RESULTS: Of the 3465 patients, 474 (14 %) were diagnosed with VTE at baseline or during 3-month follow-up. Discriminatory performance of the 4PEPS items was good (area under ROC-curve, 0.82; 95%CI, 0.80-0.84) as was calibration. Based on 4PEPS, PE could be considered ruled out without imaging in 58 % (95%CI 57-60) of patients (efficiency), for an overall failure rate of 1.3 % (95%CI 0.86-1.9). CONCLUSION: In this retrospective external validation, 4PEPS appeared to safely rule out PE with a high efficiency. Nevertheless, although not exceeding the failure rate margin by ISTH standards, the observed failure rate in our analysis appeared to be higher than in the original 4PEPS derivation and validation study. This highlights the importance of a prospective outcome study.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Performance of the 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) in the diagnostic management of pulmonary embolism: An external validation study
- Date Crossref
- 01/11/2023
- Éditeur
- Elsevier BV
- 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
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Leiden University Medical Center Department of Thrombosis and Hemostasis pays non établi dans la noticeOrganisme public
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Amsterdam University Medical Centers Department of Radiology pays non établi dans la noticeÉtablissement de santé
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University of Amsterdam pays non établi dans la noticeUniversité ou école supérieure
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Red Cross Hospital Department of Hematology pays non établi dans la noticeÉtablissement de santé
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Medisch Centrum Haaglanden pays non établi dans la noticeÉtablissement de santé
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Rijnstate Hospital Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
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University Medical Center Utrecht Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
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Erasmus MC pays non établi dans la noticeÉtablissement de santé
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Haga Hospital Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
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Radboud University Nijmegen pays non établi dans la noticeUniversité ou école supérieure
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Radboud University Medical Center Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS) pays non établi dans la noticeOrganisme public
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Amsterdam Cardiovascular Sciences pays non établi dans la noticeInstitution
Department of Thrombosis and Hemostasis — Leiden University Medical Center, Department of Radiology — Amsterdam University Medical Centers et University of Amsterdam, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.