EBQ:Wells PE Rule Out: Difference between revisions

Revision as of 01:30, 17 December 2013

Authors:

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 ==Related Publications==
+==CME==
+<quiz display=simple>
+{The utility of a quantitative D-dimer test is greatest in which of the following patients suspected of a pulmonary embolism?
+|type="()"}
++Patients with a low pre-test probability
+||ACEP clinical policy; Ann Emerg Med 2011; 57:628-650. Despite consensus guidelines that recommend using D-dimer testing on patients with intermediate pretest probability for PE, strong evidence supporting this approach is lacking. Thus, D-dimer testing is indicated in low pre-test probability patients.
+-Patients with an intermediate pre-test probability
+-Patients with a high pre-test probability
+{In which of the following patients can a negative CT pulmonary angiogram (alone) exclude the diagnosis of PE?
+|type="[]"}
++A patient with low pretest probability who required additional diagnostic testing because of a positive D-dimer
+||ACEP clinical policy; Ann Emerg Med 2011; 57:628-650. If a patient is intermediate pretest probability, then additional diagnostic testing should be considered, such as a d-dimer, lower extremity imaging, VQ scanning, or traditional pulmonary angiogram prior to exclusion of VTE. A negative highly sensitive quantitative d-dimer result in combination with a negative multidetector CT pulmonary angiogram result theoretically provides a posttest probability of VTE of less than 1%.
+-A patient with an intermediate pretest probability with a negative CT pulmonary angiogram in whom you are still concermed for PE
++A patient with an intermediate pretest probability with a negative d-dimer and a negative CT pulmonary angiogram
+-Neither of the above
+{When would venous ultrasound be indicated as the initial imaging modality when you are evaluating a person with symptoms consistent with PE?
+|type="()"}
+-Patients with obvious signs of DVT for whom venous ultrasound is readily available
+-Patients with borderline renal insufficiency
+-Patients with CT contrast agent allergy
+-Pregnant patient
++All of the above
+||ACEP clinical policy; Ann Emerg Med 2011; 57:628-650. This is a level B recommendation. A positive ultrasound in a patient with symptoms consistent with PE can be considered evidence for diagnosis of VTE and may preclude the need for additional diagnostic testing. Examples of situations in which venous ultrasound may be considered as initial imaging may include patients with obvious signs of DVT for whom ultrasound is readily available, and patients with relative contraindication for CT scan.
+</quiz>
 <references/>

	A patient with low pretest probability who required additional diagnostic testing because of a positive D-dimer
	A patient with an intermediate pretest probability with a negative CT pulmonary angiogram in whom you are still concermed for PE
	A patient with an intermediate pretest probability with a negative d-dimer and a negative CT pulmonary angiogram
	Neither of the above

	Patients with obvious signs of DVT for whom venous ultrasound is readily available
	Patients with borderline renal insufficiency
	Patients with CT contrast agent allergy
	Pregnant patient
	All of the above

EBQ:Wells PE Rule Out: Difference between revisions

Revision as of 01:30, 17 December 2013

Contents

Clinical Question

Conclusion

Design

Population Studied

Inclusion Criteria

Exclusion Criteria

Baseline Characteristics

Interventions

Outcomes

Primary Outcomes

Secondary Outcomes

Tertiary Outcomes

Discussion

Criticism

Funding

Related Publications

CME

	Patients with a low pre-test probability
	Patients with an intermediate pre-test probability
	Patients with a high pre-test probability