Key result
Initial bedside testing matches initial V/Q scanning for recurrent venous thromboembolism risk.
Why the study?
It was uncertain whether using combinations of 3 bedside tests to exclude pulmonary embolism before diagnostic imaging was as safe as starting with ventilation-perfusion scan.
Does a combination of 3 bedside tests safely exclude pulmonary embolism and reduce the need for diagnostic imaging compared to initial V/Q scan in adults with suspected pulmonary embolism?
Population
398 adults with suspected pulmonary embolism
Comparison
Initial bedside tests vs initial ventilation-perfusion scan without bedside tests
Design
Double-blind randomized controlled equivalency trial
Follow-up
3 months
Authors
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Bedside combination safely excludes PE in 34% without imaging; confirms equivalency to initial V/Q scanning.
RCT (n=399)
Double-blind
randomized
Does a combination of 3 bedside tests safely exclude pulmonary embolism and reduce the need for diagnostic imaging compared to initial V/Q scan in adults with suspected pulmonary embolism?
Absolute Event Rate: 2.4% vs 3%
p-value: p=0.76
Using a combination of 3 bedside tests safely excludes pulmonary embolism and eliminates the need for diagnostic imaging in 34% of patients with suspected PE.
Rodger et al. (2006) conducted an RCT in suspected pulmonary embolism (n=399). Initial bedside tests (7-variable clinical model, non-ELISA D-dimer test, and alveolar dead-space fraction) vs. Initial ventilation-perfusion (V/Q) scan was evaluated on recurrent venous thromboembolic events during 3 months among patients who were not taking anticoagulant agents after the initial investigations were completed (p=0.76). Using 3 bedside tests to exclude pulmonary embolism was equivalent to starting with a V/Q scan, with recurrent venous thromboembolic event rates of 2.4% vs 3.0% at 3 months (P=0.76).
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