Análisis crítico de un artículo: ¿Es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?

Context: The clinical validity of using computed tomography (CT) to diagnose peripheral pulmonary embolism is uncertain. Insufficient sensitivity for peripheral pulmonary embolism is considered the principal limitation of CT. Objective: To review studies that used a CT-based approach to rule out a d...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Abarza,Juan, Rada,Gabriel
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2007
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000400019
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:scielo:S0034-98872007000400019
record_format	dspace
spelling	oai:scielo:S0034-988720070004000192014-01-06Análisis crítico de un artículo: ¿Es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?Abarza,JuanRada,GabrielContext: The clinical validity of using computed tomography (CT) to diagnose peripheral pulmonary embolism is uncertain. Insufficient sensitivity for peripheral pulmonary embolism is considered the principal limitation of CT. Objective: To review studies that used a CT-based approach to rule out a diagnosis of pulmonary embolism. Data sources: The medical literature databases of PubMed, MEDLINE, EMBASE, CRISP, metaRegister of Controlled Trials, and Cochrane were searched for articles published in the English language from January 1990 to May 2004. Study selection: We included studies that used contrast-enhanced chest CT to rule out the diagnosis of acute pulmonary embolism, had a minimum follow-up of 3 months, and had study populations of more than 30 patients. Data extraction: Two reviewers independently abstracted patient demographics, frequency of venous thromboembolic events (VTEs), CT modality (single-slice CT, multidetector-row CT, or electron-beam CT), false-negative results, and deaths attributable to pulmonary embolism. To calculate the overall negative likelihood ratio (NLR) of a VTE after a negative or inconclusive chest CT scan for pulmonary embolism, we included VTEs that were objectively confirmed by an additional imaging test despite a negative or inconclusive CT scan and objectively confirmed VTEs that occurred during clinical follow-up of at least 3 months. Data synthesis: Fifteen studies met the inclusion criteria and contained a total of 3500 patients who were evaluated from October 1994 through April 2002. The overall NLR of a VTE after a negative chest CT scan for pulmonary embolism was 0.07 (95% confidence interval [CI], 0.05-0.11); and the negative predictive value (NPV) was 99.1% (95% CI, 98.7%-99.5%). The NLR of a VTE after a negative single-slice spiral CT scan for pulmonary embolism was 0.08 (95% CI, 0.05-0.13); and after a negative multidetector-row CT scan, 0.15 (95% CI, 0.05-0.43). There was no difference in risk of VTEs based on CT modality used (relative risk, 1.66; 95% CI, 0.47-5.94; P = .50). The overall NLR of mortality attributable to pulmonary embolism was 0.01 (95% CI, 0.01-0.02) and the overall NPV was 99.4% (95% CI, 98.7%-99.9%). Conclusion: The clinical validity of using a CT scan to rule out pulmonary embolism is similar to that reported for conventional pulmonary angiographyinfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.135 n.4 20072007-04-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000400019es10.4067/S0034-98872007000400019
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
description	Context: The clinical validity of using computed tomography (CT) to diagnose peripheral pulmonary embolism is uncertain. Insufficient sensitivity for peripheral pulmonary embolism is considered the principal limitation of CT. Objective: To review studies that used a CT-based approach to rule out a diagnosis of pulmonary embolism. Data sources: The medical literature databases of PubMed, MEDLINE, EMBASE, CRISP, metaRegister of Controlled Trials, and Cochrane were searched for articles published in the English language from January 1990 to May 2004. Study selection: We included studies that used contrast-enhanced chest CT to rule out the diagnosis of acute pulmonary embolism, had a minimum follow-up of 3 months, and had study populations of more than 30 patients. Data extraction: Two reviewers independently abstracted patient demographics, frequency of venous thromboembolic events (VTEs), CT modality (single-slice CT, multidetector-row CT, or electron-beam CT), false-negative results, and deaths attributable to pulmonary embolism. To calculate the overall negative likelihood ratio (NLR) of a VTE after a negative or inconclusive chest CT scan for pulmonary embolism, we included VTEs that were objectively confirmed by an additional imaging test despite a negative or inconclusive CT scan and objectively confirmed VTEs that occurred during clinical follow-up of at least 3 months. Data synthesis: Fifteen studies met the inclusion criteria and contained a total of 3500 patients who were evaluated from October 1994 through April 2002. The overall NLR of a VTE after a negative chest CT scan for pulmonary embolism was 0.07 (95% confidence interval [CI], 0.05-0.11); and the negative predictive value (NPV) was 99.1% (95% CI, 98.7%-99.5%). The NLR of a VTE after a negative single-slice spiral CT scan for pulmonary embolism was 0.08 (95% CI, 0.05-0.13); and after a negative multidetector-row CT scan, 0.15 (95% CI, 0.05-0.43). There was no difference in risk of VTEs based on CT modality used (relative risk, 1.66; 95% CI, 0.47-5.94; P = .50). The overall NLR of mortality attributable to pulmonary embolism was 0.01 (95% CI, 0.01-0.02) and the overall NPV was 99.4% (95% CI, 98.7%-99.9%). Conclusion: The clinical validity of using a CT scan to rule out pulmonary embolism is similar to that reported for conventional pulmonary angiography
author	Abarza,Juan Rada,Gabriel
spellingShingle	Abarza,Juan Rada,Gabriel Análisis crítico de un artículo: ¿Es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?
author_facet	Abarza,Juan Rada,Gabriel
author_sort	Abarza,Juan
title	Análisis crítico de un artículo: ¿Es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?
title_short	Análisis crítico de un artículo: ¿Es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?
title_full	Análisis crítico de un artículo: ¿Es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?
title_fullStr	Análisis crítico de un artículo: ¿Es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?
title_full_unstemmed	Análisis crítico de un artículo: ¿Es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?
title_sort	análisis crítico de un artículo: ¿es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?
publisher	Sociedad Médica de Santiago
publishDate	2007
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000400019
work_keys_str_mv	AT abarzajuan analisiscriticodeunarticuloesseguronotratarapacientesconsospechadetromboembolismopulmonarytomografiaaxialcomputarizadanegativa AT radagabriel analisiscriticodeunarticuloesseguronotratarapacientesconsospechadetromboembolismopulmonarytomografiaaxialcomputarizadanegativa
_version_	1718436318059429888

Análisis crítico de un artículo: ¿Es seguro no tratar a pacientes con sospecha de tromboembolismo pulmonar y tomografía axial computarizada negativa?

Ejemplares similares