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.
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.
Nonsurgical biopsy is also recommended when the patient's pretest probability
and imaging test results are discordant, when a benign diagnosis requires specific medical treatment, or if a fully informed patient desires proof of diagnosis prior to surgery.
This is important because the predictive value of the exercise stress test depends on the pretest probability
of disease and the population at risk (2).
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.
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.
4) An understanding of the patient population, patient pretest probability
of CAD, Bayes' theorem, and the risk, benefits and limitations of each technology will enable the medical imaging professional to assist clinicians with test selection.
In their study, 3%, 17% and 75% of the patients with low, mode and high pretest probability
, respectively, had DVT.
There is a high negative predictive value when the pretest probability
A negative ultrasound with a likely pretest probability
of DVT indicates the need for repeat imaging.
Because a number of situations other than DVT and PE can elevate serum levels of d-dimer Table IIa scoring method using a clinical assessment model to determine pretest probability
of DVT and PE has been useful in the diagnostic approach.