Article Instance

HTTP 200 OK
Allow: GET
Content-Type: application/json
Vary: Accept

{
    "pk": 11284,
    "title": "Ruling out Pulmonary Embolism in Patients with High Pretest Probability",
    "subtitle": null,
    "abstract": "Introduction: \nThe American College of Emergency Physicians guidelines recommend more aggressive workup beyond imaging alone in patients with a high pretest probability (PTP) of pulmonary embolism (PE). However, the ability of multiple tests to safely rule out PE in high PTP patients is not known. We sought to measure the ability of negative computed tomography pulmonary angiography (CTPA) along with negative D-dimer to rule out PE in these high-risk patients.\nMethods:\n We analyzed data from a previous prospective observational study conducted in 12 emergency departments (ED). Wells score criteria were entered by providers before final PE testing. PE was diagnosed by imaging on the index ED visit, or within 45 days, demonstrating either PE ordeep vein thrombosis (DVT), or if the patient died of PE during the 45-day, follow-up period. Testing threshold was set at 1.8%.\nResults:\n A total of 7,940 patients were enrolled and tested for PE, and 257 had high PTP (Wells >6). Sixteen of these high-risk patients had negative CTPA and negative D-dimer, of whom two were positive for PE (12.5% [95% confidence interval 2.2%-40.0%]). One of these patients had a DVT on CT venogram and the other was diagnosed at follow-up.\nConclusion:\n Our analysis suggests that in patients with high PTP of PE, neither negative CTPA by itself nor a negative CTPA plus a negative D-dimer are sufficient to rule out PE. More aggressive workup strategies may be required for these patients.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [],
    "section": "Treatment Protocol Assessment",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/74h4h8qb",
    "frozenauthors": [
        {
            "first_name": "Murtaza",
            "middle_name": "",
            "last_name": "Akhter",
            "name_suffix": "",
            "institution": "University of Arizona College of Medicine-Phoenix, Maricopa Integrated Health System, Department of Emergency Medicine, Phoenix, Arizona",
            "department": "None"
        },
        {
            "first_name": "Jeffrey",
            "middle_name": "",
            "last_name": "Kline",
            "name_suffix": "",
            "institution": "Indiana University School of Medicine, Department of Emergency Medicine and\nDepartment of Cellular and Integrative Physiology, Indianapolis, Indiana",
            "department": "None"
        },
        {
            "first_name": "Bikash",
            "middle_name": "",
            "last_name": "Bhattarai",
            "name_suffix": "",
            "institution": "University of Arizona College of Medicine-\nPhoenix, Maricopa Integrated Health System,Department of Medicine Administration, Phoenix, Arizona",
            "department": "None"
        },
        {
            "first_name": "Mark",
            "middle_name": "",
            "last_name": "Courtney",
            "name_suffix": "",
            "institution": "Northwestern University’s Feinberg School of\nMedicine, Department of Emergency Medicine, Chicago, Illinois",
            "department": "None"
        },
        {
            "first_name": "Christopher",
            "middle_name": "",
            "last_name": "Kabrhel",
            "name_suffix": "",
            "institution": "Massachusetts General Hospital, Department of Emergency Medicine, Center for\nVascular Emergencies, Boston, Massachusetts.\nHarvard Medical School, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        }
    ],
    "date_submitted": "2017-08-27T00:36:25Z",
    "date_accepted": "2017-08-27T00:36:25Z",
    "date_published": "2018-03-08T15:51:35Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11284/galley/6134/download/"
        }
    ]
}