Arnaud Perrier, MD; Henri Bounameaux, MD
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Perrier A., Bounameaux H.; Ultrasonography of Leg Veins in Patients Suspected of Having Pulmonary Embolism. Ann Intern Med. 1998;128:243. doi: 10.7326/0003-4819-128-3-199802010-00015
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Published: Ann Intern Med. 1998;128(3):243.
TO THE EDITOR:
In their study on the diagnostic utility of lower-limb venous compression ultrasonography in patients suspected of having pulmonary embolism , Turkstra and colleagues found that ultrasonography had a sensitivity of 29% (95% CI, 22% to 37%) and a specificity of 97% (CI, 94% to 99%). On the basis of these results (a low sensitivity and a suboptimal positive predictive value), they conclude that “compression ultrasonography should be used with great caution in patients suspected of having pulmonary embolism.”
We disagree with that conclusion on several grounds. First, the low sensitivity may be explained by the inclusion of both inpatients and outpatients. In our recent outcome study of 671 consecutive outpatients presenting to an emergency department with suspected pulmonary embolism  (in which we used an ultrasonography protocol similar to that used by Turkstra and colleagues), we found a higher sensitivity-51% (CI, 44% to 58%). On the other hand, in an ongoing study of inpatients, sensitivity of ultrasonography seems lower (approximately 30%) in patients hospitalized in medical and surgical wards; this probably reflects a higher proportion of deep venous thrombosis of the calf in this population.
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