ArticleBMC pulmonary medicine2022
Comparing 'clinical hunch' against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism.
Article in BMC pulmonary medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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13 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Diagnostic accuracy of transthoracic echocardiography for the identification of proximal aortic dissection: a systematic review and meta-analysis.Scientific reports · 2023Pooled it
- Overuse of imaging for pulmonary embolism in emergency departments: a systematic review and meta-analysis.International journal of emergency medicine · 2026Review
- Machine learning improves prediction of pulmonary thromboembolism and reduces unnecessary computed tomography scans in the emergency department.Scientific reports · 2026Article
- Comparative analysis of clinical decision tools for acute pulmonary embolism at a tertiary care center.Bioinformation · 2026Article
- Application of a diagnostic strategy for patients with suspected pulmonary embolism in a middle-income country.BMC pulmonary medicine · 2025Observational
- D-dimers or more? Assessing the role of laboratory factors in predicting and confirming pulmonary embolism in high-risk orthopedic patients.Practical laboratory medicine · 2025Article
- Prediction of pulmonary embolism by an explainable machine learning approach in the real world.Scientific reports · 2025Article
- A Comparative Analysis of the Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Infection on the Performance of Clinical Decision-Making Algorithms for Pulmonary Embolism.Journal of clinical medicine · 2024Article
- [Diagnostics and treatment of pulmonary artery embolisms].Radiologie (Heidelberg, Germany) · 2024Article
- Detection of acute pulmonary embolism using native repeated magnetic resonance imaging acquisitions under free-breathing and without respiratory or cardiac gating. A diagnostic accuracy study.European journal of radiology open · 2024Article
- Beyond the fractures: A comprehensive Comparative analysis of Affordable and Accessible laboratory parameters and their coefficients for prediction and Swift confirmation of pulmonary embolism in high-risk orthopedic patients.Practical laboratory medicine · 2024Article
- Overuse of Computed Tomography Pulmonary Angiography and Low Utilization of Clinical Prediction Rules in Suspected Pulmonary Embolism Patients at a Regional Australian Hospital.Healthcare (Basel, Switzerland) · 2024Article
- Machine Learning-Based Prediction of Pulmonary Embolism Prognosis Using Nutritional and Inflammatory Indices.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
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5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPulmonary embolism (PE) is a common and potentially life-threatening condition. Since it is considered a 'do not miss' diagnosis, PE tends to be over-investigated beyond the evidence-based clinical decision support systems (CDSS), which in turn subjects patients to unnecessary radiation and contrast agent exposure with no apparent benefits in terms of outcome. The purpose of this study was to evaluate the yield of 'clinical hunch' (gestalt) and four CDSS: the PERC Rule, Wells score, revised Geneva score, and Years criteria.
methodsA review was conducted on the Electronic Medical Records (EMR) of 1566 patients from the Emergency Department at a tertiary teaching hospital who underwent CTPA from the 1st of January 2018 to the 31st of December 2019. The scores for the four CDSS were calculated retrospectively from the EMR data. We considered that a CTPA had been ordered on a clinical hunch when there was no mention of CDSS in the EMR, and no D-dimer test. A bypass of CDSS was confirmed when any step of the diagnostic algorithms was not followed.
resultsOf the total 1566 patients who underwent CTPA, 265 (17%) were positive for PE. The diagnosis yield from the five decision groups (clinical hunch and four CDSS) was as follows-clinical hunch, 15%; PERC rule, 18% (6% when bypassed); Wells score, 19% (11% when bypassed); revised Geneva score, 26% (13% when bypassed); and YEARS criteria, 18% (6% when bypassed).
conclusionClinicians should trust the evidence-based clinical decision support systems in line with the international guidelines to diagnose PE.
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