The Rational Clinical Examination
David L. Simel, Drummond Rennie
Thoracic Aortic Dissection
Michael Klompas
Sixteen studies examining 1553 patients report sensitivities for various components of the...
Topics Discussed:
aorta thoracic ascending dissection, chest x-ray, diagnostic process, dissection of aorta, likelihood ratio, sensitivity, summarizing the evidence
Excerpt:
"Sixteen studies examining 1553 patients report sensitivities
for various components of the clinical history in Table
50-2. Most patients with dissection have a documented history
of hypertension (sensitivity, 64%); however, the LR+ of
this history is 1.6 (95% CI, 1.2-2.0). The pooled prevalence
of the Marfan syndrome in this group of studies was 5% (95% CI, 4%-7%).
Given that the Marfan syndrome afflicts only 0.02% to 0.03% of
the general population,58 the high prevalence of
the Marfan syndrome in these series is suggestive of a markedly
increased risk associated with this disorder, though the frequency
of the Marfan syndrome detected in these series likely reflects
the inclusion biases of these studies. The one controlled study
that assessed for the Marfan syndrome generated an LR+ of
4.1.29..."
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