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Arnaud Perrier - One of the best experts on this subject based on the ideXlab platform.

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    JAMA Internal Medicine, 2001
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    Objective To develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected pulmonary embolism (PE) into groups with a high, intermediate, or low probability of PE to improve and simplify the diagnostic approach. Methods Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. Results A total of 296 (27%) of 1090 patients were found to have PE. The optimal estimate of clinical probability was based on 8 variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis, or elevation of a hemidiaphragm on chest x-ray film. A probability score was calculated by adding points assigned to these variables. A cutoff score of 4 best identified patients with low probability of PE. A total of 486 patients (49%) had a low clinical probability of PE (score ≤4), of which 50 (10.3%) had a proven PE. The prevalence of PE was 38% in the 437 patients with an intermediate probability (score of 5-8; n = 437) and 81% in the 63 patients with a high probability (score ≥9). Conclusions This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of having PE could allow a more effective diagnostic process.

  • predicting adverse outcome in patients with acute pulmonary embolism a risk score
    Thrombosis and Haemostasis, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Arnaud Perrier, Alain Junod
    Abstract:

    Reliable prediction of adverse outcomes in acute pulmonary embolism may help choose between in-hospital and ambulatory treatment. We aimed to identify predictors of adverse events in patients with pulmonary embolism and to generate a simple risk score for use in clinical settings. We prospectively followed 296 consecutive patients with pulmonary embolism admitted through the Emergency Ward. Logistic regression was used to predict death, recurrent thromboembolic event, or major bleeding at 3 months. Thirty patients (10.1%) had one or more adverse events during the 3-month follow-up period: 25 patients (8.4%) died, thromboembolic events recurred in 10 patients (3.4%), and major bleeding occurred in 5 patients (1.7%). Factors associated with an adverse outcome in multivariate analysis were cancer, heart failure, previous deep vein thrombosis, systolic blood pressure

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    Journal of General Internal Medicine, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    PURPOSE: We aimed to develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected PE into groups with a high, intermediate, or low probability of PE, in order to improve and simplify the diagnostic approach. METHODS: Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE, in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS: 296 out of 1090 patients (27%) were found to have PE. The optimal estimate of clinical probability was based on eight variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis or elevation of a hemidiaphragm on chest X-ray. A probability score was calculated by adding points assigned to these variables. A cut-off score of 4 best identified patients with low probability of PE. 486 patients (49%) had a low clinical probability of PE (score 9). CONCLUSION: This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of PE could allow a more efficient diagnostic process.

  • non invasive diagnosis of venous thromboembolism in outpatients
    The Lancet, 1999
    Co-Authors: Arnaud Perrier, Sylvie Desmarais, M J Miron, P De Moerloose, Raymond Lepage, Daniel O Slosman, Dominique Didier, Pierre Unger, Jeanvictor Patenaude, Henri Bounameaux
    Abstract:

    Summary Background We designed a simple and integrated diagnostic algorithm for acute venous thromboembolism based on clinical probability assessment of deep-vein thrombosis (DVT) or pulmonary embolism (PE), plasma D-dimer measurement, lower-limb venous compression ultrasonography, and lung scan to reduce the need for phlebography and pulmonary angiography. Methods 918 consecutive patients presenting at the Emergency Ward of the Geneva University Hospital, Geneva, Switzerland, and Hopital Saint-Luc, Montreal, Canada, with clinically suspected venous thromboembolism were entered into a sequential diagnostic protocol. Patients in whom venous thromboembolism was deemed absent were not given anticoagulants and were followed up for 3 months. Findings A normal D-dimer concentration ( Interpretation A diagnostic strategy combining clinical assessment, D-dimer, ultrasonography, and lung scan gave a non-invasive diagnosis in the vast majority of outpatients with suspected venous thromboembolism, and appeared to be safe.

Jacques Wicki - One of the best experts on this subject based on the ideXlab platform.

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    JAMA Internal Medicine, 2001
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    Objective To develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected pulmonary embolism (PE) into groups with a high, intermediate, or low probability of PE to improve and simplify the diagnostic approach. Methods Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. Results A total of 296 (27%) of 1090 patients were found to have PE. The optimal estimate of clinical probability was based on 8 variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis, or elevation of a hemidiaphragm on chest x-ray film. A probability score was calculated by adding points assigned to these variables. A cutoff score of 4 best identified patients with low probability of PE. A total of 486 patients (49%) had a low clinical probability of PE (score ≤4), of which 50 (10.3%) had a proven PE. The prevalence of PE was 38% in the 437 patients with an intermediate probability (score of 5-8; n = 437) and 81% in the 63 patients with a high probability (score ≥9). Conclusions This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of having PE could allow a more effective diagnostic process.

  • predicting adverse outcome in patients with acute pulmonary embolism a risk score
    Thrombosis and Haemostasis, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Arnaud Perrier, Alain Junod
    Abstract:

    Reliable prediction of adverse outcomes in acute pulmonary embolism may help choose between in-hospital and ambulatory treatment. We aimed to identify predictors of adverse events in patients with pulmonary embolism and to generate a simple risk score for use in clinical settings. We prospectively followed 296 consecutive patients with pulmonary embolism admitted through the Emergency Ward. Logistic regression was used to predict death, recurrent thromboembolic event, or major bleeding at 3 months. Thirty patients (10.1%) had one or more adverse events during the 3-month follow-up period: 25 patients (8.4%) died, thromboembolic events recurred in 10 patients (3.4%), and major bleeding occurred in 5 patients (1.7%). Factors associated with an adverse outcome in multivariate analysis were cancer, heart failure, previous deep vein thrombosis, systolic blood pressure

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    Journal of General Internal Medicine, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    PURPOSE: We aimed to develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected PE into groups with a high, intermediate, or low probability of PE, in order to improve and simplify the diagnostic approach. METHODS: Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE, in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS: 296 out of 1090 patients (27%) were found to have PE. The optimal estimate of clinical probability was based on eight variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis or elevation of a hemidiaphragm on chest X-ray. A probability score was calculated by adding points assigned to these variables. A cut-off score of 4 best identified patients with low probability of PE. 486 patients (49%) had a low clinical probability of PE (score 9). CONCLUSION: This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of PE could allow a more efficient diagnostic process.

Alain Junod - One of the best experts on this subject based on the ideXlab platform.

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    JAMA Internal Medicine, 2001
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    Objective To develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected pulmonary embolism (PE) into groups with a high, intermediate, or low probability of PE to improve and simplify the diagnostic approach. Methods Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. Results A total of 296 (27%) of 1090 patients were found to have PE. The optimal estimate of clinical probability was based on 8 variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis, or elevation of a hemidiaphragm on chest x-ray film. A probability score was calculated by adding points assigned to these variables. A cutoff score of 4 best identified patients with low probability of PE. A total of 486 patients (49%) had a low clinical probability of PE (score ≤4), of which 50 (10.3%) had a proven PE. The prevalence of PE was 38% in the 437 patients with an intermediate probability (score of 5-8; n = 437) and 81% in the 63 patients with a high probability (score ≥9). Conclusions This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of having PE could allow a more effective diagnostic process.

  • predicting adverse outcome in patients with acute pulmonary embolism a risk score
    Thrombosis and Haemostasis, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Arnaud Perrier, Alain Junod
    Abstract:

    Reliable prediction of adverse outcomes in acute pulmonary embolism may help choose between in-hospital and ambulatory treatment. We aimed to identify predictors of adverse events in patients with pulmonary embolism and to generate a simple risk score for use in clinical settings. We prospectively followed 296 consecutive patients with pulmonary embolism admitted through the Emergency Ward. Logistic regression was used to predict death, recurrent thromboembolic event, or major bleeding at 3 months. Thirty patients (10.1%) had one or more adverse events during the 3-month follow-up period: 25 patients (8.4%) died, thromboembolic events recurred in 10 patients (3.4%), and major bleeding occurred in 5 patients (1.7%). Factors associated with an adverse outcome in multivariate analysis were cancer, heart failure, previous deep vein thrombosis, systolic blood pressure

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    Journal of General Internal Medicine, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    PURPOSE: We aimed to develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected PE into groups with a high, intermediate, or low probability of PE, in order to improve and simplify the diagnostic approach. METHODS: Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE, in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS: 296 out of 1090 patients (27%) were found to have PE. The optimal estimate of clinical probability was based on eight variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis or elevation of a hemidiaphragm on chest X-ray. A probability score was calculated by adding points assigned to these variables. A cut-off score of 4 best identified patients with low probability of PE. 486 patients (49%) had a low clinical probability of PE (score 9). CONCLUSION: This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of PE could allow a more efficient diagnostic process.

Thomas Perneger - One of the best experts on this subject based on the ideXlab platform.

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    JAMA Internal Medicine, 2001
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    Objective To develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected pulmonary embolism (PE) into groups with a high, intermediate, or low probability of PE to improve and simplify the diagnostic approach. Methods Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. Results A total of 296 (27%) of 1090 patients were found to have PE. The optimal estimate of clinical probability was based on 8 variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis, or elevation of a hemidiaphragm on chest x-ray film. A probability score was calculated by adding points assigned to these variables. A cutoff score of 4 best identified patients with low probability of PE. A total of 486 patients (49%) had a low clinical probability of PE (score ≤4), of which 50 (10.3%) had a proven PE. The prevalence of PE was 38% in the 437 patients with an intermediate probability (score of 5-8; n = 437) and 81% in the 63 patients with a high probability (score ≥9). Conclusions This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of having PE could allow a more effective diagnostic process.

  • predicting adverse outcome in patients with acute pulmonary embolism a risk score
    Thrombosis and Haemostasis, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Arnaud Perrier, Alain Junod
    Abstract:

    Reliable prediction of adverse outcomes in acute pulmonary embolism may help choose between in-hospital and ambulatory treatment. We aimed to identify predictors of adverse events in patients with pulmonary embolism and to generate a simple risk score for use in clinical settings. We prospectively followed 296 consecutive patients with pulmonary embolism admitted through the Emergency Ward. Logistic regression was used to predict death, recurrent thromboembolic event, or major bleeding at 3 months. Thirty patients (10.1%) had one or more adverse events during the 3-month follow-up period: 25 patients (8.4%) died, thromboembolic events recurred in 10 patients (3.4%), and major bleeding occurred in 5 patients (1.7%). Factors associated with an adverse outcome in multivariate analysis were cancer, heart failure, previous deep vein thrombosis, systolic blood pressure

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    Journal of General Internal Medicine, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    PURPOSE: We aimed to develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected PE into groups with a high, intermediate, or low probability of PE, in order to improve and simplify the diagnostic approach. METHODS: Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE, in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS: 296 out of 1090 patients (27%) were found to have PE. The optimal estimate of clinical probability was based on eight variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis or elevation of a hemidiaphragm on chest X-ray. A probability score was calculated by adding points assigned to these variables. A cut-off score of 4 best identified patients with low probability of PE. 486 patients (49%) had a low clinical probability of PE (score 9). CONCLUSION: This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of PE could allow a more efficient diagnostic process.

Henri Bounameaux - One of the best experts on this subject based on the ideXlab platform.

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    JAMA Internal Medicine, 2001
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    Objective To develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected pulmonary embolism (PE) into groups with a high, intermediate, or low probability of PE to improve and simplify the diagnostic approach. Methods Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. Results A total of 296 (27%) of 1090 patients were found to have PE. The optimal estimate of clinical probability was based on 8 variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis, or elevation of a hemidiaphragm on chest x-ray film. A probability score was calculated by adding points assigned to these variables. A cutoff score of 4 best identified patients with low probability of PE. A total of 486 patients (49%) had a low clinical probability of PE (score ≤4), of which 50 (10.3%) had a proven PE. The prevalence of PE was 38% in the 437 patients with an intermediate probability (score of 5-8; n = 437) and 81% in the 63 patients with a high probability (score ≥9). Conclusions This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of having PE could allow a more effective diagnostic process.

  • predicting adverse outcome in patients with acute pulmonary embolism a risk score
    Thrombosis and Haemostasis, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Arnaud Perrier, Alain Junod
    Abstract:

    Reliable prediction of adverse outcomes in acute pulmonary embolism may help choose between in-hospital and ambulatory treatment. We aimed to identify predictors of adverse events in patients with pulmonary embolism and to generate a simple risk score for use in clinical settings. We prospectively followed 296 consecutive patients with pulmonary embolism admitted through the Emergency Ward. Logistic regression was used to predict death, recurrent thromboembolic event, or major bleeding at 3 months. Thirty patients (10.1%) had one or more adverse events during the 3-month follow-up period: 25 patients (8.4%) died, thromboembolic events recurred in 10 patients (3.4%), and major bleeding occurred in 5 patients (1.7%). Factors associated with an adverse outcome in multivariate analysis were cancer, heart failure, previous deep vein thrombosis, systolic blood pressure

  • assessing clinical probability of pulmonary embolism in the Emergency Ward a simple score
    Journal of General Internal Medicine, 2000
    Co-Authors: Jacques Wicki, Thomas Perneger, Henri Bounameaux, Alain Junod, Arnaud Perrier
    Abstract:

    PURPOSE: We aimed to develop a simple standardized clinical score to stratify Emergency Ward patients with clinically suspected PE into groups with a high, intermediate, or low probability of PE, in order to improve and simplify the diagnostic approach. METHODS: Analysis of a database of 1090 consecutive patients admitted to the Emergency Ward for suspected PE, in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS: 296 out of 1090 patients (27%) were found to have PE. The optimal estimate of clinical probability was based on eight variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis or elevation of a hemidiaphragm on chest X-ray. A probability score was calculated by adding points assigned to these variables. A cut-off score of 4 best identified patients with low probability of PE. 486 patients (49%) had a low clinical probability of PE (score 9). CONCLUSION: This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to Emergency Ward patients suspected of PE could allow a more efficient diagnostic process.

  • non invasive diagnosis of venous thromboembolism in outpatients
    The Lancet, 1999
    Co-Authors: Arnaud Perrier, Sylvie Desmarais, M J Miron, P De Moerloose, Raymond Lepage, Daniel O Slosman, Dominique Didier, Pierre Unger, Jeanvictor Patenaude, Henri Bounameaux
    Abstract:

    Summary Background We designed a simple and integrated diagnostic algorithm for acute venous thromboembolism based on clinical probability assessment of deep-vein thrombosis (DVT) or pulmonary embolism (PE), plasma D-dimer measurement, lower-limb venous compression ultrasonography, and lung scan to reduce the need for phlebography and pulmonary angiography. Methods 918 consecutive patients presenting at the Emergency Ward of the Geneva University Hospital, Geneva, Switzerland, and Hopital Saint-Luc, Montreal, Canada, with clinically suspected venous thromboembolism were entered into a sequential diagnostic protocol. Patients in whom venous thromboembolism was deemed absent were not given anticoagulants and were followed up for 3 months. Findings A normal D-dimer concentration ( Interpretation A diagnostic strategy combining clinical assessment, D-dimer, ultrasonography, and lung scan gave a non-invasive diagnosis in the vast majority of outpatients with suspected venous thromboembolism, and appeared to be safe.