Comparison of a clinical probability estimate and two clinical models in patients with suspected pulmonary embolism. ANTELOPE-Study Group.
Recent studies have suggested that both the subjective judgement of a physician and standardized clinical models can be helpful in the estimation of the probability of the disease in patients with suspected pulmonary embolism (PE). We performed a multi-center study in consecutive in- and outpatients with suspected PE to compare the potential diagnostic utility of these methods. Of the 517 study patients, 160 (31%) were classified as having PE. Of these patients, 14% had a low probability as estimated by the treating physician, while 25 to 36% were categorized as having a low clinical probability with the use of two previously described clinical models. The objectively confirmed prevalence of PE in these three low probability categories was 19%, 28% and 28%, respectively. The three methods yielded comparable predictive values for PE in the other probability categories. We conclude that a physician's clinical judgement alone and two standardized clinical models, although comparable, perform disappointingly in categorizing the pre-test probability in patients with suspected PE.
Sanson
B J
BJ
Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. b.j.sanson@amc.uva.nl
Lijmer
J G
JG
Mac Gillavry
M R
MR
Turkstra
F
F
Prins
M H
MH
Büller
H R
HR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001158:Arteries / Q000473:pathology; D003661:Decision Support Techniques; D003936:Diagnosis, Computer-Assisted; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015588:Observer Variation; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results