Kearon et al, (16) demonstrated the utility of D-dimer testing alone in excluding PE in low pretest probability
patients, however, that alone cannot be used to exclude PE in patients with moderate to high risk of developing PE.
Situations Test preferred Test not preferred Cyclic Cushing's syndrome  UFC or LNSC DST Mild Cushing's syndrome  LNSC or DST UFC Pseudo Cushing's syndrome  LNSC or DST UFC CS patients on antiepileptics  UFC or LNSC DST Adrenal incidentaloma  DST UFC or LNSC Pregnancy  UFC DST, LNSC Severe chronic kidney disease  DST or LNSC UFC Low pretest probability
 UFC High pretest probability
 LNSC UFC: urinary free cortisol; LNSC: late-night salivary cortisol; DST: dexamethasone suppression test.
In the most extreme scenario, where every negative level III test is followed by an in-lab test to confirm a diagnosis of OSA, our analysis still demonstrates that the HM pathway has a cheaper per-patient cost than the SL pathway in a population with a moderate pretest probability
It was found in the study that coronary CT angiogram based strategy was safe for the evaluation of acute pain chest presumably of cardiac origin with low and intermediate pretest probability
of coronary artery disease.
For each patient, pretest probability
was determined using UDFM as previously described.
For a patient with a solid nodule >8 mm to 3 cm, ACCP guidelines suggest that physicians estimate the pretest probability
of malignancy qualitatively using their clinical judgment and/- or quantitatively by using a validated model, such as the Mayo model described above.
Therefore the clinical profile of the patient and the pretest probability
are important in assessing the test result.
Using LRs, one can calculate the posttest probability for any given pretest probability
Tool for estimating pretest probability
of coronary heart disease Variable Score Example: 52- year-old woman Age (male/female): -Under 40/under 50 3 -40 to 50/50 to 64 6 6 -55 or older/65 or older 9 Estrogen status positive (F) -3 -3 Estrogen status negative (F) 3 Angina history typical * 5 Angina history atypical 3 Angina history nonanginal 1 1 Diabetes 2 2 Hyperlipidemia 1 1 Hypertension 1 Smoking (any) 1 First-degree family history 1 1 of coronary artery disease Obesity (BMI >27 kg/[m.sup.2]) 1 1 Total score 9 Risk according to total score Low: 0 to 8 Intermediate: 9 High: 16 or to 15 greater Source: Morise AP, Jalisi F.
This is because the level of clinical suspicion or pretest probability
may be low in this racial group.
Tips for teachers of evidence-based medicine: clinical prediction rules (CPRs) and estimating pretest probability
. J Gen Intern Med 2008; 23: 1261-8.
Using electronic records and chart review, they sought to identify differences in the use of stress testing based on patient demographics and comorbidities, pretest probability
of coronary artery disease, and house staff coverage.