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Diagnostic Strategies for Excluding Pulmonary Embolism in Clinical Outcome Studies: A Systematic Review

Marieke J.H.A. Kruip, MD; Monique G.L. Leclercq, MD; Cees van der Heul, MD; Martin H. Prins, MD; and Harry R. Büller, MD
[+] Article and Author Information

From St. Elisabeth Hospital, Tilburg; Medisch Spectrum Twente, Enschede; University of Maastricht, Maastricht; and Academic Medical Centre, Amsterdam, the Netherlands.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Marieke J.H.A. Kruip, MD, Department of Internal Medicine, St. Elisabeth Hospital, Postbus 90151, 5000 LC Tilburg, the Netherlands; e-mail, evert.janssen@zonnet.nl.

Current Author Addresses: Drs. Kruip and van der Heul: Department of Internal Medicine, St. Elisabeth Hospital, Postbus 90151, 5000 LC Tilburg, the Netherlands.

Dr. Leclercq: Department of Internal Medicine, Medisch Spectrum Twente, Postbus 50000, 7500 KA Enschede, the Netherlands.

Dr. Prins: Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, Postbus 616, NL 6200 MD Maastricht, the Netherlands.

Dr. Büller: Department of Vascular Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.

Author Contributions: Conception and design: M.J.H.A. Kruip, M.G.L. Leclercq, M.H. Prins, H.R. Büller.

Analysis and interpretation of the data: M.J.H.A. Kruip, M.G.L. Leclercq, C. van der Heulm, M.H. Prins, H.R. Büller.

Drafting of the article: M.J.H.A. Kruip, C. van der Heul.

Critical revision of the article for important intellectual content: M.J.H.A. Kruip, M.G.L. Leclercq, C. van der Heul, M.H. Prins, H.R. Büller.

Final approval of the article: M.J.H.A. Kruip, M.H. Prins, H.R. Büller.

Provision of study materials or patients: M.J.H.A. Kruip.

Statistical expertise: M.H. Prins.

Collection and assembly of data: M.J.H.A. Kruip.


Ann Intern Med. 2003;138(12):941-951. doi:10.7326/0003-4819-138-12-200306170-00005
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We identified 77 studies. Of these, 52 were excluded because they did not meet the predefined selection criteria (1869) (Figure). Therefore, 25 studies including more than 7000 patients with clinical suspicion of pulmonary embolism in whom the diagnosis was ruled out by a particular strategy (7, 9, 1215, 17, 7087) met all selection criteria and were available for our analysis. We divided the diagnostic strategies into tests done in all referred patients, tests performed after a first diagnostic round, and tests performed in patients with nondiagnostic results after two diagnostic rounds. Among the similar diagnostic strategies, no heterogeneity in the incidence of venous thromboembolism was observed. Table 1 lists the main characteristics of each study.

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Study selection.

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Summary for Patients

Excluding Pulmonary Embolism Safely

The summary below is from the full report titled “Diagnostic Strategies for Excluding Pulmonary Embolism in Clinical Outcome Studies. A Systematic Review.” It is in the 17 June 2003 issue of Annals of Internal Medicine (volume 138, pages 941-951). The authors are M.J.H.A. Kruip, M.G.L. Leclercq, C. van der Heul, M.H. Prins, and H.R. Büller.

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