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Our algorithm for diagnosing pulmonary thromboembolism combines ventilation/perfusion scanning with clinical criteria. Our perfusion scanning criterion states that high probability defines 2 segmental perfusion defects without corresponding radiographic abnormality and indeterminate probability defines less than 2 segmental perfusion defects (low probability: less than one segmental perfusion defect; intermediate: perfusion defects between high and low probability). The clinical criterion is divided into 7 items related to symptoms and signs suggestive of pulmonary thromboembolism. More than 4 items are defined as a highly suspicious clinical manifestation (HSCM), and less than 4 are considered a low suspicious clinical manifestation (LSCM). In 31 cases of high probability, 18 of HSCM did not include pulmonary angiography (PAG), and 13 of LSCM included PAG (positive: 11; negative: 2). In 12 cases of indeterminate probability, 7 of LSCM were observed without PAG and 5 of HSCM with PAG (positive: 4; negative: 1). PAG performance thus decreased to 41.9%. The positive prediction of high probability is 93.5%, which is very high, compared to indeterminate probability at 33.3%.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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