Difference between revisions of "Template:Pulmonary embolism - need for investigation and choice of modality"
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===Choice of modality=== | ===Choice of modality=== | ||
| − | [[File:Radiologist algorithm for pulmonary embolism.png|center|300px]] | + | [[File:Radiologist algorithm for pulmonary embolism.png|center|300px]] |
| − | == | + | In pregnant and elderly patients, corresponding D-dimer ranges need to be used.<ref group="notes"> |
| − | {{ | + | ;Pregnant patients |
| + | The following are [[reference range]]s for D-dimer: | ||
| + | {|class="wikitable" | ||
| + | ! Units !! Nonpregnant <br>adult !! First [[Pregnancy|trimester]] !! Second trimester !! Third trimester | ||
| + | |- | ||
| + | | mg/L or µg/mL || < 0.5 || 0.05 - 0.95 || 0.32 - 1.29 || 0.13 -1.7 | ||
| + | |- | ||
| + | | µg/L or ng/mL || < 500|| 50 - 950 || 320 - 1290 || 130 - 1700 | ||
| + | |- | ||
| + | | nmol/L || < 2.7 || 0.3 - 5.2 || 1.8 - 7.1 || 0.7 - 9.3 | ||
| + | |} | ||
| + | <font size=1>Reference: [http://www.perinatology.com/Reference/Reference%20Ranges/D-Dimer.htm Reference Values During Pregnancy] at perinatology.com. Retrieved October 2014.</font> | ||
| + | |||
| + | ;Elderly patients: | ||
| + | Patient’s age in years × 10 µg/L (or x 0.056 nmol/L) for patients aged over 50 years for the suspicion of venous thromboembolism (VTE). | ||
| + | :<font size=1>Reference: {{cite journal |vauthors=Urban K, Kirley K, Stevermer JJ |title=PURLs: It's time to use an age-based approach to D-dimer |journal=J Fam Pract |volume=63 |issue=3 |pages=155–8 |date=March 2014 |pmid=24701602 |pmc=4042909 |doi= |url=}}</ref><ref>{{cite journal |last1=Raja |first1=Ali S. |last2=Greenberg |first2=Jeffrey O. |last3=Qaseem |first3=Amir |last4=Denberg |first4=Thomas D. |last5=Fitterman |first5=Nick |last6=Schuur |first6=Jeremiah D. |title=Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians |journal=Annals of Internal Medicine |date=29 September 2015 |volume=163 |issue=9 |pages=701 |doi=10.7326/M14-1772 |pmid=26414967}}</font><noinclude> | ||
| + | {{Bottom}} | ||
</noinclude> | </noinclude> | ||
Revision as of 15:34, 19 July 2019
Need for investigation
The indication can effectively be determined by clinical scoring, followed by D-dimer in those less likely to have pulmonary embolism.[1] By Well's score, CT is indicated at a score over 4:[1]
| Feature | Points |
|---|---|
| Signs and symptoms of deep vein thrombosis, at least with leg swelling and pain upon palpation of deep veins. | 3 |
| No alternative diagnosis better explains the presentation | 3 |
| Heart rate over 100/min | 1.5 |
| Immobilization >3 days or surgery in past 4 weeks | 1.5 |
| Previous pulmonary embolism or deep vein thrombosis | 1.5 |
| Hemoptysis | 1 |
| Malignancy (current or treated in the past 6 months) | 1 |
Choice of modality
In pregnant and elderly patients, corresponding D-dimer ranges need to be used.[notes 1]<ref>Raja, Ali S.; Greenberg, Jeffrey O.; Qaseem, Amir; Denberg, Thomas D.; Fitterman, Nick; Schuur, Jeremiah D. (29 September 2015). "Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians ". Annals of Internal Medicine 163 (9): 701. doi:. PMID 26414967.
Notes
- ↑
- Pregnant patients
Units Nonpregnant
adultFirst trimester Second trimester Third trimester mg/L or µg/mL < 0.5 0.05 - 0.95 0.32 - 1.29 0.13 -1.7 µg/L or ng/mL < 500 50 - 950 320 - 1290 130 - 1700 nmol/L < 2.7 0.3 - 5.2 1.8 - 7.1 0.7 - 9.3 Reference: Reference Values During Pregnancy at perinatology.com. Retrieved October 2014.
- Elderly patients
Patient’s age in years × 10 µg/L (or x 0.056 nmol/L) for patients aged over 50 years for the suspicion of venous thromboembolism (VTE).
". J Fam Pract 63 (3): 155–8. March 2014. PMID 24701602.
References
