CoChat
Sign Up
Cited by 350Venous Thromboembolism Diagnosis and ManagementCardiovascular and Diving-Related ComplicationsBlood Coagulation and Thrombosis Mechanisms

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.

Diagnosis of Pulmonary Embolism with d -Dimer Adjusted to Clinical Probability

Open access
Kearon, Clive, de Wit, Kerstin, Parpia, Sameer, Schulman, Sam, Afilalo, Marc, Hirsch, Andrew, Spencer, Frederick A., Sharma, Sangita, D’Aragon, Frédérick, Deshaies, Jean-François, Le Gal, Gregoire, Lazo-Langner, Alejandro, Wu, Cynthia, Rudd-Scott, Lisa, Bates, Shannon M., Julian, Jim A.·2019·New England Journal of Medicine
DOI 10.1056/nejmoa1909159
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Retrospective analyses suggest that pulmonary embolism is ruled out by a d-dimer level of less than 1000 ng per milliliter in patients with a low clinical pretest probability (C-PTP) and by a d-dimer level of less than 500 ng per milliliter in patients with a moderate C-PTP. METHODS: We performed a prospective study in which pulmonary embolism was considered to be ruled out without further testing in outpatients with a low C-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter. All other patients underwent chest imaging (usually computed tomographic pulmonary angiography). If pulmonary embolism was not diagnosed, patients did not receive anticoagulant therapy. All patients were followed for 3 months to detect venous thromboembolism. RESULTS: A total of 2017 patients were enrolled and evaluated, of whom 7.4% had pulmonary embolism on initial diagnostic testing. Of the 1325 patients who had a low C-PTP (1285 patients) or moderate C-PTP (40 patients) and a negative d-dimer test (i.e., <1000 or <500 ng per milliliter, respectively), none had venous thromboembolism during follow-up (95% confidence interval [CI], 0.00 to 0.29%). These included 315 patients who had a low C-PTP and a d-dimer level of 500 to 999 ng per milliliter (95% CI, 0.00 to 1.20%). Of all 1863 patients who did not receive a diagnosis of pulmonary embolism initially and did not receive anticoagulant therapy, 1 patient (0.05%; 95% CI, 0.01 to 0.30) had venous thromboembolism. Our diagnostic strategy resulted in the use of chest imaging in 34.3% of patients, whereas a strategy in which pulmonary embolism is considered to be ruled out with a low C-PTP and a d-dimer level of less than 500 ng per milliliter would result in the use of chest imaging in 51.9% (difference, -17.6 percentage points; 95% CI, -19.2 to -15.9). CONCLUSIONS: A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up. (Funded by the Canadian Institutes of Health Research and others; PEGeD ClinicalTrials.gov number, NCT02483442.).

Overview

Integrity signals

Registry

Crossref · 10.1056/nejmoa1909159

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Clinical and demographic information can be used to infer the clinical pretest probability of Aβ+ based on standard clinical assessments.

    “As the prevalence of amyloid-β pathology is closely linked to age and clinical syndrome18–20, clinical and demographic information can be used to infer the clinical pretest probability of amyloid-β positivity (Aβ+) based on standard clinical assessments17,21,22.”

    From Diagnosis of Alzheimer's disease using plasma biomarkers adjusted to clinical probability (2024) · cites this paper as [21]

Citations

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Metadata

Authors
Kearon, C., de Wit, K., Parpia, S., Schulman, S., Afilalo, M., Hirsch, A., Spencer, F. A., Sharma, S., D’Aragon, F., Deshaies, J.-F., Le Gal, G., Lazo-Langner, A., Wu, C., Rudd-Scott, L., Bates, S. M., & Julian, J. A.
Affiliations
  • Université de Sherbrooke (CA)
  • From the Departments of Medicine (C.K., K.W., S. Schulman, F.A.S., S. Sharma, S.M.B.), Health Research Methods, Evidence, and Impact (C.K., S.P., S. Schulman), and Oncology (S.P., L.R.-S., J.A.J.), McMaster University, Hamilton, ON, the Departments of Emergency Medicine (M.A.) and Medicine (A.H.), McGill University, Montreal, the Departments of Anesthesia (F.D.) and Family and Emergency Medicine (J.-F.D.), Sherbrooke University, Sherbrooke, QC, the Department of Medicine, University of Ottawa,...
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2019-11-28
Volume
381
Issue
22
Pages
2125-2134
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1909159
OpenAlex
W2990973273
Cited by
349
References
45
Citations by year
2026: 39 · 2025: 42 · 2024: 56 · 2023: 50 · 2022: 49 · 2021: 69 · 2020: 43 · 2019: 1
FWCI
31.02
Type
journal article
Language
en
Open access
Licence
www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research (MOP-130249)
Topics
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Keywords
pulmonary embolism, D-dimer, clinical probability, venous thromboembolism, diagnostic approach, CT pulmonary angiography, anticoagulation, outpatients, diagnostic cost reduction, diagnostic accuracy, sensitivity and specificity, negative predictive value, positive predictive value
MeSH terms
Computed Tomography Angiography, Clinical Decision Rules, Adult, Aged, Female, Fibrin Fibrinogen Degradation Products, Humans, Male, Middle Aged, Predictive Value of Tests, Probability, Prospective Studies, Pulmonary Embolism

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review