medigraphic.com
Colegio de Medicina Interna de México.

2018, Number 5

<< Back Next >>

Med Int Mex 2018; 34 (5)

PERC prediction rule and D-dimer adjusted for age: two new strategies in the diagnosis of acute pulmonary embolism

Salazar-Arenas JA, Agreda D, Pulido-Arenas J, Celis-Preciado CA

Language: Spanish
References: 81
Page: 715-729
PDF size: 549.47 Kb.


ABSTRACT

Pulmonary embolism is a high incidence disease despite underdiagnosis and carries a high risk of morbidity and mortality. The current pre-test tools (clinical, probability scales and D-dimer) have allowed to optimize the diagnostic accuracy, since it is problematic to select the subgroup of patients who will obtain a greater benefit from the practice of an angiotomography to establish the diagnosis of pulmonary embolism. This paper reviews critically the published evidence on the PERC scale and the adjusting of the D-dimer with age for the diagnosis of acute pulmonary embolism. As structured review of the medical literature on PubMed, Tripdatabase and Epistemonikos databases was made. Search was limited to meta-analysis, randomized studies, cohort studies, review articles and treatment guidelines without limits on language or date of publication, using MESH terms: d-dimer, pulmonary embolism, diagnosis. It was performed the reading of the title and abstract of 1512 references of which 50 were selected as representative for the subject of this review. We wrote the manuscript after classification and data extraction. The use of the PERC scale and age-adjusted D-dimer are recommended in the diagnostic approach of the patient with pulmonary embolism.


REFERENCES

  1. Lloyd-Jones D, et al; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics: 2010 update: a report from the American Heart Association. Circulation 2010;121:e46-e215.

  2. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol 2008;28:370-372.

  3. Cohen AT, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98:756-764.

  4. Pineda LA, et al. Clinical suspicion of fatal pulmonary embolism. Chest 2001;120:791-5.

  5. Dennis R y col. Estudio nacional sobre tromboembolismo venoso en población hospitalaria en Colombia, diferencias entre ciudades y especialidades. Acta Méd Col 1996;21:55-63.

  6. Dennis RJ, et al. Curso clínico y supervivencia en embolia pulmonar. Resultados del registro multicéntrico colombiano (EMEPCO). Acta Méd Col 2008;33:111-16.

  7. Raskob GE, et al. Chapter 134. Venous thrombosis. In: Lichtman MA, Kipps TJ, Seligsohn U, Kaushansky K, Prchal JT, eds. Williams Hematology, 8th ed. New York, NY: McGraw-Hill; 2010.

  8. Ghali WA, et al. New methods for estimating pretest probability in the diagnosis of pulmonary embolism. Current Opinion in Pulmonary Medicine 2001;7(5).

  9. Lucassen W, et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med 2011;155:448-60.

  10. Stein PD, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004;140:589-602.

  11. Wells PS, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001;135:98-107.

  12. Perrier A, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med 2004;116:291-299.

  13. van Belle A, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295:172-179.

  14. Douma RA, et al. Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism: a prospective cohort study. Ann Intern Med 2011;154:709-718.

  15. Le Gal G, et al. Diagnosing pulmonary embolism: running after the decreasing prevalence of cases among suspected patients. J Thromb Haemost JTH 2004;2:1244-6.

  16. Wiener RS, et al. When a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be found. BMJ 2013;347:f3368-8.

  17. Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med 2011;171:831-7.

  18. Schissler AJ, et al. CT pulmonary angiography: increasingly diagnosing less severe pulmonary emboli. PLoS One 2013;8:e65669.

  19. Hutchinson BD, Navin P, Marom EM, Truong MT, Bruzzi JF. Overdiagnosis of Pulmonary Embolism by Pulmonary CT Angiography. AJR Am J Roentgenol 2015;205:271-7.

  20. Jha S. The road to overdiagnosis: the case of subsegmental pulmonary embolism. Acad Radiol 2015;22:985-7.

  21. Wilke T, et al. [Renal impairment in patients with thromboembolic event: prevalence and clinical implications. A systematic review of the literature]. Dtsch Med Wochenschr 2015;140:e166-74.

  22. Rose TA Jr, et al. Intravenous imaging contrast media complications: The basics that every clinician needs to know. Am J Med 2015;128:943-9.

  23. Einstein AJ, et al. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA J Am Med Assoc 2007;298:317-23.

  24. JRehnberg JV, et al. Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 3: Pulmonary embolism rule-out criteria (PERC) for excluding pulmonary embolism. Emerg Med J 2014;31:81-2.

  25. Lang E. In suspected PE, an age-adjusted D-dimer cutpoint improved ability to exclude PE. Ann Intern Med 2014;161:JC13.

  26. Righini M, et al. Should the D-dimer cut-off value be increased in elderly patients suspected of pulmonary embolism? Thromb Haemost 2001;85:744.

  27. Perrier A, et al. D-dimer testing for suspected pulmonary embolism in outpatients. Am J Respir Crit Care Med 1997;156:492-6.

  28. Tardy B, et al. Evaluation of D-dimer ELISA test in elderly patients with suspected pulmonary embolism. Thromb Haemost 1998;79:38-41.

  29. Masotti L, et al. Plasma D-dimer levels in elderly patients with suspected pulmonary embolism. Thromb Res 2000;98:577-9.

  30. Righini M, et al. Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med 2000;109:357-361.

  31. Kline JA, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004;2(8):1247-55.

  32. Hogg K, et al. Application of pulmonary embolism rule-out criteria to the UK Manchester Investigation of Pulmonary Embolism Diagnosis (MIOPED) study cohort. J Thromb Haemost 2005;3:592-3.

  33. Wolf SJ, et al. Assessment of the pulmonary embolism rule-out criteria rule for evaluation of suspected pulmonary embolism in the emergency department. Am J Emerg Med 2008;26:181-5.

  34. Kline JA, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008;6:772-80.

  35. Carpenter CR, et al; Best Evidence in Emergency Medicine Investigator Group. Differentiating low-risk and no-risk PE patients: the PERC score. J Emerg Med 2009;36:317-22.

  36. Kline JA, et al. Prospective evaluation of real-time use of the pulmonary embolism rule-out criteria in an academic emergency department. Acad Emerg Med 2010;17:1016-9.

  37. Dachs RJ, et al. The Pulmonary Embolism Rule-Out Criteria rule in a community hospital ED: a retrospective study of its potential utility. Am J Emerg Med 2011;29:1023-7.

  38. Penaloza A, et al. Performance of the Pulmonary Embolism Rule-out Criteria (the PERC rule) combined with low clinical probability in high prevalence population. Thromb Res 2012;129:e189-93.

  39. Singh B, et al. Diagnostic accuracy of pulmonary embolism rule-out criteria: a systematic review and meta-analysis. Ann Emerg Med 2012;59:517-20.e1-4.

  40. Singh B, et al. Pulmonary embolism rule-out criteria (PERC) in pulmonary embolism--revisited: a systematic review and meta-analysis. Emerg Med J 2013;30:701-6.

  41. Huckins DS, et al. Utilization and yield of chest computed tomographic angiography associated with low positive Ddimer levels. J Emerg Med 2012;43:211-20.

  42. Crichlow A, et al. Overuse of computed tomography pulmonary angiography in the evaluation of patients with suspected pulmonary embolism in the emergency department. Acad Emerg Med 2012;19:1219-26.

  43. Aydoğdu M, et al. Wells score and Pulmonary Embolism Rule Out Criteria in preventing over investigation of pulmonary embolism in emergency departments. Tuberk Toraks 2014;62:12-21.

  44. Bokobza J, et al. Pulmonary Embolism Rule-out Criteria vs D-dimer testing in low-risk patients for pulmonary embolism: a retrospective study. Am J Emerg Med 2014;32:609-13.

  45. Bozarth AL, et al. Evaluation of the pulmonary embolism rule-out criteria in a retrospective cohort at an urban academic hospital. Am J Emerg Med 2015;33:483-7.

  46. Stojanovska J, et al. CT Pulmonary angiography: using decision rules in the emergency department. J Am Coll Radiol 2015;12:1023-9.

  47. Theunissen J, et al. A retrospective analysis of the combined use of PERC rule and Wells score to exclude pulmonary embolism in the Emergency Department. Emerg Med J 2016;33:696-701.

  48. Crane S, et al. Retrospective validation of the pulmonary embolism rule-out criteria rule in 'PE unlikely' patients with suspected pulmonary embolism. Eur J Emerg Med 2016 Dec 19. [Epub ahead of print].

  49. Mongan J, et al. Age and sex-dependent trends in pulmonary embolism testing and derivation of a clinical decision rule for young patients. Emerg Med J 2015;32:840-5.

  50. Richardson S, et al. Healthcare provider perceptions of clinical prediction rules. BMJ Open 2015;5:e008461.

  51. Hugli O, et al. The pulmonary embolism rule-out criteria (PERC) rule does not safely exclude pulmonary embolism. J Thromb Haemost 2011;9:300-4.

  52. Schwartz DT. Problems with PERC. Ann Emerg Med 2010;56:584-7.

  53. Bossart PJ. Misuse of the pulmonary embolism rule-out criteria. Ann Emerg Med 2012;60:820.

  54. Freund Y, et al. PERC rule to exclude the diagnosis of pulmonary embolism in emergency low-risk patients: study protocol for the PROPER randomized controlled study. Trials 2015;16:537.

  55. Douma RA, et al. Potential of an age adjusted D-dimer cutoff value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts. BMJ 2010;340:c1475.

  56. Douma RA, et al. Age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded. Haematologica 2012;97:1507-13.

  57. Penaloza A, et al. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. J Thromb Haemost 2012;10:1291-6.

  58. Van Es J, et al. The combination of four different clinical decision rules and an age-adjusted D-dimer cut-off increases the number of patients in whom acute pulmonary embolism can safely be excluded. Thromb Haemost 2012;107:167-71.

  59. Schouten HJ, et al. Validation of two age dependent Ddimer cut-off values for exclusion of deep vein thrombosis in suspected elderly patients in primary care: retrospective, cross sectional, diagnostic analysis. BMJ 2012;344: e2985.

  60. Schouten HJ, et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ 2013;346:f2492.

  61. Righini M, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA 2014;311:1117-24.

  62. Polo Friz H, et al. A higher d-dimer threshold safely rulesout pulmonary embolism in very elderly emergency department patients. Thromb Res 2014;133:380-3.

  63. Mullier F, et al. Comparison of five D-dimer reagents and application of an age-adjusted cut-off for the diagnosis of venous thromboembolism in emergency department. Blood Coagul Fibrinolysis 2014;25:309-15.

  64. Woller SC, et al. Assessment of the safety and efficiency of using an age-adjusted D-dimer threshold to exclude suspected pulmonary embolism. Chest 2014;146:1444- 51.

  65. Gupta A, et al. Assessing 2 D-dimer age-adjustment strategies to optimize computed tomographic use in ED evaluation of pulmonary embolism. Am J Emerg Med 2014;32:1499-502.

  66. Sharp AL, et al. An age-adjusted D-dimer threshold for emergency department patients with suspected pulmonary embolus: accuracy and clinical implications. Ann Emerg Med 2015 Aug 27. pii: S0196-0644(15)00616-2.

  67. Flores J, et al. Clinical usefulness and safety of an ageadjusted D-dimer cutoff levels to exclude pulmonary embolism: a retrospective analysis. Intern Emerg Med 2015 [Epub ahead of print].

  68. Altmann MM, et al. Age-dependent D-dimer cut-off to avoid unnecessary CT-exams for ruling-out pulmonary embolism. Rofo 2015;187:795-800.

  69. Han C, et al. The performance of age-adjusted D-dimer cut-off in Chinese outpatients with suspected venous thromboembolism. Thromb Res 2015;136:739-43.

  70. Pickering L, et al. Use of the age-adjusted D-dimer as a screening tool for pulmonary thromboembolic disease in an older inpatient population. Clin Med (Lond) 2016;16 Suppl 3:s7.

  71. Fuchs E, et al. Age-adjusted cutoff D-dimer level to rule out acute pulmonary embolism: A validation cohort study. Am J Med 2016;129:872-8.

  72. Polo Friz H, et al. Prognostic value of D-dimer in elderly patients with pulmonary embolism. J Thromb Thrombolysis 2016;42:386-92.

  73. Nobes J, et al. Age-adjusted D-dimer excludes pulmonary embolism and reduces unnecessary radiation exposure in older adults: retrospective study. Postgrad Med J 2016 Dec 9. [Epub ahead of print].

  74. Jaconelli T, et al. Can an age-adjusted D-dimer level be adopted in managing venous thromboembolism in the emergency department? A retrospective cohort study. Eur J Emerg Med 2017 Jan 10. [Epub ahead of print].

  75. van Es N, et al. The original and simplified Wells rules and age-adjusted D-dimer testing to rule out pulmonary embolism: an individual patient data meta-analysis. J Thromb Haemost 2017 Jan 20. [Epub ahead of print].

  76. Takach Lapner S, et al. Questioning the use of an age-adjusted D-dimer threshold to exclude venous thromboembolism: analysis of individual patient data from two diagnostic studies. J Thromb Haemost 2016 Oct;14(10):1953-1959.

  77. Stein CE, et al. Missed diagnosis of pulmonary embolism with age-adjusted d-dimer cut-off value. Age Ageing 2016 Nov;45(6):910-911.

  78. Goodwin AJ, et al. Issues surrounding age-adjusted D-dimer cutoffs that practicing physicians need to know when evaluating patients with suspected pulmonary embolism. Ann Intern Med 2017 Mar 7;166(5):361-363.

  79. Konstantinides SV, et al; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033-69.

  80. Raja AS, et al; Clinical Guidelines Committee of the American College of Physicians. Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2015;163:701-11.

  81. Giannitsis E, et al; Biomarker Study Group of the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA). How to use D-dimer in acute cardiovascular care. Eur Heart J Acute Cardiovasc Care 2015 [Epub ahead of print].




2020     |     www.medigraphic.com