如何准确解读急性肺栓塞的基本检查.PDF

ANZHEN HOSPITAL 如何准确解读急性肺栓塞的基本检查 首都医科大学附属北京安贞医院EICU 米玉红 ANZHEN HOSPITAL 诸多陷阱等着你 症状（胸闷…触发因素？；晕厥…伴随症状？；PAP…原因？） 临床评分： ANZHEN HOSPITAL Clinical scoring systems • wells score （DVT ，PTE ） JAMA Intern Med. 2015 Jul;175(7):1112-7.. • Genava score Performance of Wells Score for Deep Vein Thrombosis in the Inpatient Setting • modified Genava score RESULTS: In a study cohort of 1135 inpatients, 137 (12.1%) had proximal DVT. Proximal DVT incidence in low, moderate, and high pretest • PESI or sPESI probability groups was 5.9% (8 of 135), 9.5% (48 of 506), and 16.4% (81 of 494), respectively (P  .001). The area under the receiver operating characteristics curve for the discriminatory accuracy of the Wells score for risk of proximal DVT identified on lower- • PERC (pulmonary embolism rule-out criteria) extremity venous duplex ultrasound studies was 0.60. The failure rate of the Wells score to classify patients with a low pretest probability was 5.9% (95% CI, 3.0%-11.3%); the efficiency was 11.9% (95% CI, 10.1%-13.9%). • Padua score CONCLUSIONS AND RELEVANCE: The Wells score performed only slightly better than chance for discrimination of risk for DVT in hospitalized patients. It had a higher failure rate and a lower efficiency in the inpatient setting compared with that reported in the outpatient literature. Therefore, the Wells score risk stratification is not sufficient to rule out DVT or influence management decisions in the inpatient setting. ANZHEN HOSPITAL Padua评分标准 危险因素 评分 活动性恶性肿瘤或6月内接受放疗或化疗