 |
|
The Low-Probability Lung ScanA Need for Change in Nomenclature
Russell D. Hull, MBBS, MSc;
Gary E. Raskob, MSc;
Graham F. Pineo, MD;
Rollin F. Brant, PhD
Arch Intern Med. 1995;155(17):1845-1851.
Abstract
| |
Background
The prognosis in patients with suspected pulmonary embolism who have a low-probability lung scan has been the focus of much clinical debate. This is particularly so in patients with underlying cardiac and pulmonary disease, because these disorders frequently cause low-probability lung scans in the absence of pulmonary embolism. Historically, the clinical response has been to exclude pulmonary embolism and withhold treatment on the basis of a low-probability lung scan, which has been regarded as synonymous with a good prognosis.
Methods
A prospective cohort-analytic study to evaluate prognosis, using long-term follow-up, in patients with inadequate cardiorespiratory reserve who have presented with suspected pulmonary embolism (inadequate cardiorespiratory reserve, ie, pulmonary edema, right-ventricular failure, hypotension, syncope, acute tachyarrhythmia, abnormal spirometry [forced expiratory volume in 1 second, < 1.0, or vital capacity, < 1.5 L], or abnormal arterial blood gases [PO2, < 50 mm Hg, or PCO2, > 45 mm Hg]).
Results
The outcomes of the 77 consecutive patients with low-probability lung scans, suspected pulmonary embolism, and inadequate cardiorespiratory reserve were compared with those in 711 consecutive patients with good cardiorespiratory reserve and nondiagnostic lung scans who were entered into the study over the same period of time. Six (7.8%) of the 77 patients died within days of entry with autopsy-proven pulmonary embolism compared with one (0.14%) of the 711 patients with nondiagnostic lung scans (P<.0001).
Conclusions
Our findings indicate that the term low-probability lung scan should be abandoned in reference to patients with inadequate cardiorespiratory reserve, because it is not synonymous with a good prognosis and is, indeed, misleading.
(Arch Intern Med. 1995;155:1845-1854)
Author Affiliations
From the Clinical Trials Unit, University of Calgary, Alberta.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Diagnosis of pulmonary embolism in hospitalised patients: retrospective survey of an institutional standard
Jouveshomme et al.
Eur Respir J 2007;30:1117-1123.
ABSTRACT
| FULL TEXT
Diagnosing Pulmonary Embolism With Improved Certainty and Simplicity
Hull
JAMA 2006;295:213-215.
FULL TEXT
Small Pulmonary Emboli: What Do We Know?
Goodman
Radiology 2005;234:654-658.
FULL TEXT
Clinicians' Response to Radiologists' Reports of Isolated Subsegmental Pulmonary Embolism or Inconclusive Interpretation of Pulmonary Embolism Using MDCT
Eyer et al.
Am. J. Roentgenol. 2005;184:623-628.
ABSTRACT
| FULL TEXT
Symptomatic Venous Thromboembolism in Cancer Patients Treated With Chemotherapy: An Underestimated Phenomenon
Otten et al.
Arch Intern Med 2004;164:190-194.
ABSTRACT
| FULL TEXT
Distribution of Ventilation/Perfusion Ratios in Pulmonary Embolism: An Adjunct to the Interpretation of Ventilation/Perfusion Lung Scans
Itti et al.
JNM 2002;43:1596-1602.
ABSTRACT
| FULL TEXT
Screening for subclinical deep-vein thrombosis
Kelly et al.
QJM 2001;94:511-519.
FULL TEXT
Venous Thromboembolism After Acute Stroke
Kelly et al.
Stroke 2001;32:262-267.
ABSTRACT
| FULL TEXT
Sensitivity and Specificity of Helical Computed Tomography in the Diagnosis of Pulmonary Embolism: A Systematic Review
Rathbun et al.
ANN INTERN MED 2000;132:227-232.
ABSTRACT
| FULL TEXT
Review of 6-Month Mortality Following Low-Probability Lung Scans
Rajendran and Jacobson
Arch Intern Med 1999;159:349-352.
ABSTRACT
| FULL TEXT
Pulmonary Embolism
Goldhaber
NEJM 1998;339:93-104.
FULL TEXT
Clinical overview of venous thromboembolism
Goldhaber
Vasc Med 1998;3:35-40.
ABSTRACT
|
