Thromb Haemost 2006; 95(06): 958-962
DOI: 10.1160/TH06-02-0114
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Influence of specific alternative diagnoses on the probability of pulmonary embolism

Ariane Testuz
1   Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
2   Service of General Internal Medicine, Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Grégoire Le Gal
1   Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
2   Service of General Internal Medicine, Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Marc Righini
1   Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Henri Bounameaux
1   Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Arnaud Perrier
2   Service of General Internal Medicine, Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
› Author Affiliations
Financial support: The present study was supported by a grant from the Hirsch Fund of the University of Geneva.
Further Information

Publication History

Received 24 February 2006

Accepted after revision 18 April 2006

Publication Date:
30 November 2017 (online)

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Summary

The presence and likelihood of an alternative diagnosis to pulmonary embolism is an important variable of the Wells’ prediction rule for establishing clinical probability. We assessed whether evoking specific alternative diagnoses would reduce the probability of pulmonary embolism enough to forego further testing. We retrospectively studieda cohort of 965 consecutive patients admitted for suspicion of pulmonary embolism at three medical centers in Europe in whom the presence of an alternative diagnosis at least as likely as pulmonary embolism was recorded before diagnostic testing. We divided the patients into 15 categories of alternative diagnoses evoked. We then assessed the prevalence of pulmonary embolism in each diagnostic category and compared it to the prevalence of pulmonary embolism ina reference group (patients with no alternative diagnosis or a diagnosis less likely than pulmonary embolism). The prevalence of pulmonary embolism in the reference group was 48%. The presence of an alternative diagnosis as or more likely strongly reduced the probability of pulmonary embolism (OR 0.15, 95% CI: 0.1–0.2, p<0.01). In almost every diagnostic category, the prevalence of pulmonary embolism was much lower than in the reference group whith an odds ratio below or near 0. 2. Bronchopneumonia (OR 0.4, 95% CI 0.2 to 0.7) and cancer (OR 0.6, 95% CI 0. 3 to 1.5) reduced the likelihood of pulmonary embolism toa lower extent. Evoking an alternative diagnosis at least as likely as pulmonary embolism reduces the probability of the disease, but this effect is never large enough to allow ruling it out without further testing, especially when bronchopneumonia or cancer are the alternative diagnoses considered.

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