The Rational Clinical Examination
David L. Simel, Drummond Rennie
Pulmonary Embolus
Sanjeev Chunilal, Ginsberg Jeff, Phil Wells
Make the Diagnosis: Pulmonary Embolus
Topics Discussed:
arteriography, clinical gestalt, fibrin d-dimer assay, likelihood ratio, make the diagnosis, prior probability, probability, pulmonary embolism, venous thrombosis, wells dvt score
Excerpt:
"Venous thrombosis occurs in 1 to 2 persons per 1000 person-years,
with approximately one-half to one-third of these episodes from
pulmonary embolism.18 In published studies, the prevalence
of pulmonary embolism in patients who present with a clinical suspicion
ranges from 9% to more than 30%,19 which
undoubtedly relates to a combination of factors, including differences
in referral patterns and health practices among countries, as well
as differences in patient populations. The prior probability of
a pulmonary embolus is determined from the clinical findings. Although studies
vary in the prevalence of disease, a useful guideline would be to
think of "low probability" as approximately less
than 15% and "moderate probability" as
15% to 35%...."
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