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Methodology and Clinical Implementation of Ventilation/Perfusion Tomography for Diagnosis and Follow-up of Pulmonary Embolism and Other Pulmonary Diseases
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Before performing imaging tests, it is recommended to estimate the clinical probability for PE [7]. Usually, a Wells score is applied. The measurement of D-dimer – a breakdown product of cross-linked fibrin clot – is widely used in the investigative workup of patients with suspected venous thromboembolism. However, D-dimer has a low specificity (40%) because a number of conditions, other than venous thromboembolism, may cause it to be elevated: For example, acute myocardial infarction, stroke, inflammation, active cancer, and pregnancy. The specificity declines even further with age and, in the elderly, may reach only 10 per cent [8]. Due to the low predictive value, a positive quantitative D-dimer test does not modify the pre-test probability. A negative quantitative D-dimer test combined with a low clinical probability is associated with a low risk of thromboembolic disease. At moderate to high pre-test clinical probability, D-dimer has no incremental value.
Vascular Surgery
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Centres may recommend performing a Wells score in patients suspected to have a DVT (Table 14.2.1). If the score is ≥2 then a DVT is likely and a proximal leg vein USS should be carried out to confirm. If the score is 1 or less, then a D-dimer blood test should be performed. If D-dimer is raised, a proximal leg vein USS should be performed. If, in either instance, the USS cannot be performed within 4 hours, LMWH should be administered. Once the USS has confirmed the diagnosis, interim therapeutic anticoagulation should be started.
Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
How will you determine the likelihood that this patient has had a PE?Although PE is not diagnosed by history or physical examination alone, a scoring system (e.g. Wells score) should be used to determine the pre-test probability of PE before further investigations.Wells ScoreClinical probabilityTotal score of 0–1: low probability (∼10%)Total score of 2–6: moderate probability (∼30%)Total score of >6: high probability (∼65%)In this case, the Wells score is 8.5
Prevalence and Risk Factors for Pulmonary Embolism in Pediatric Sickle Cell Disease: A National Administrative Database Study
Published in Pediatric Hematology and Oncology, 2023
Natasha Bala, Joseph Stanek, Vilmarie Rodriguez, Anthony Villella
Pulmonary embolism (PE) is a potential life-threatening condition that requires timely diagnosis and management. The incidence of PE in hospitalized pediatric population in the United States (US) has shown an upward trend in recent years with a 200% increase from the year 2001 to 2014.5 The reported higher incidence of PE in children could be attributed to the increased survival of children with complex medical chronic conditions achieved through more aggressive therapies and interventions that posed an increased risk for VTE such as CVL and surgical procedures. Obesity and exposure to hormonal therapy are additional risk factors adding to thrombosis risk. Unlike adults, there is no validated evidence based clinical probability scoring tool applicable to the pediatric age group that can evaluate the risk for a child to have PE. Studies have shown that the Wells score, which is a commonly used validated clinical probability score for evaluating PE in adults, lacks utility in the pediatric population.6,7 This makes the diagnosis of PE reliant on clinical signs, symptoms, and predisposing VTE risk factors for the clinician to initiate the work up of PE in children.
Current best clinical practices for monitoring of interstitial lung disease
Published in Expert Review of Respiratory Medicine, 2022
Elisabeth Bendstrup, Sissel Kronborg-White, Janne Møller, Thomas Skovhus Prior
High-resolution computed tomography (HRCT) is the key imaging modality for diagnosing ILD, but there is no consensus on the use of HRCT regarding disease monitoring and many centers do not perform HRCT routinely. This is partly due to the exposure to ionizing radiation, accessibility, and cost. Also, it is not clear if the HRCT evaluation should only include change of extent of fibrosis or also change of specific features like change from an inflammatory pattern with e.g. ground glass opacities to a fibrotic pattern with more reticulation (Figure 1) [39]. Recommended scanning protocols are non-contrast, volumetric acquisition, and re-construction of thin CT-images [40]. Expiratory images are only recommended for diagnostic HRCT, and not for follow-up scans, but can be advised if certain differential diagnostic diseases are considered. Quantitative CT scoring systems and artificial intelligence (AI) are still research tools and have not yet been validated for clinical use due to amongst others, lack of standard criteria to validate the accuracy of the findings and different artifacts such as patient motion, variation in inspiratory and expiratory effort and differences in the hardware and software systems that might lead to inaccurate classification of the radiologic findings [39]. Newer techniques are being tested to overcome these challenges to make the evaluation more objective. Also, different semi-quantitative scoring systems are being explored as prognostic tools but are so far mostly used for research purposes [41]. The Wells score is, however, validated and used for prognostic purposes in patients with scleroderma [42].
Sensitivity and specificity of three-point compression ultrasonography test performed by emergency physicians for diagnosis of lower limbs deep venous thrombosis
Published in Egyptian Journal of Anaesthesia, 2021
Eman Helmi Ahmed El-Gazzar, Asmaa Mohamed Alkafafy, Hassan Abd El-Salam Fathi, Tamer Abdullah Helmi, Assem Abd-Elrazek Abd-Rabo
Also, Silveira et al. [18] studied the performance of Wells score for DVT in inpatients and outpatients. They stated that it had a higher failure rate and lower efficiency in the inpatient setting compared with that reported in the outpatient. Proximal DVT incidence was low probability in 5.9%, moderate in 9.5%, and high 16.4%, in-between the inpatients (p < 0.001) compared with the much broader range for outpatients, and low probability in 3.0%, moderate probability in 16.6%, and high probability in 74.6%. This may be attributed to the use of anticoagulants in the inpatient.