Comparison of the unstructured clinician estimate of pretest probability for pulmonary embolism to the Canadian score and the Charlotte rule

A prospective observational study

Michael S. Runyon, William B. Webb, Alan E. Jones, Jeffrey Kline

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Objectives: Clinical decision rules have been validated for estimation of pretest probability in patients with suspected pulmonary embolism (PE). However, many clinicians prefer to use clinical gestalt for this purpose. The authors compared the unstructured clinical estimate of pretest probability for PE with two clinical decision rules. Methods: This prospective, observational study was conducted from October 2001 to July 2004 at an urban academic emergency department with an annual census of 105,000. A total of 2,603 patients were enrolled; mean age (±SD) was 45 (±16) years, and 70% were female. All patients were evaluated for PE using a previously published protocol, including D-dimer and alveolar dead space measurements, and selected use of pulmonary vascular imaging. All had 45-day follow-up. Interobserver agreement for each pretest probability estimation method was measured in a separate group of 154 patients. Results: The overall prevalence of PE was 5.8% (95% confidence interval [CI] = 4.9% to 6.8%). Most were deemed low risk for PE, including 69% by the unstructured estimate

Original languageEnglish (US)
Pages (from-to)587-593
Number of pages7
JournalAcademic Emergency Medicine
Volume12
Issue number7
DOIs
StatePublished - Jul 2005
Externally publishedYes

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Pulmonary Embolism
Observational Studies
Prospective Studies
Censuses
Blood Vessels
Hospital Emergency Service
Confidence Intervals
Lung

Keywords

  • Clinical decision rules
  • D-dimer
  • Gestalt theory
  • Pretest probability
  • Pulmonary embolism
  • Sensitivity and specificity

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Comparison of the unstructured clinician estimate of pretest probability for pulmonary embolism to the Canadian score and the Charlotte rule : A prospective observational study. / Runyon, Michael S.; Webb, William B.; Jones, Alan E.; Kline, Jeffrey.

In: Academic Emergency Medicine, Vol. 12, No. 7, 07.2005, p. 587-593.

Research output: Contribution to journalArticle

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