Utilidad de los modelos predictivos de embolia pulmonar / Usefulness of predictive models of pulmonary embolism

ANTECEDENTES: Ante la sospecha de embolia pulmonar (EP), las guías recomiendan el empleo de escalas de probabilidad clínica, medición del dímero D y, en determinados casos, confirmar mediante angiografía pulmonar mediante tomografía computarizada (APTC) o gammagrafía. Recientemente se ha planteado ajustar el dímero D según edad o usar escalas más sencillas (algoritmo YEARS) para una mejor selección de los pacientes. OBJETIVO: Definir el grado de aplicación de las guías en nuestra población y comparar sensibilidad, especificidad y valores predictivos positivo y negativo de los diferentes modelos diagnósticos: modelo estándar (Wells 2 categorías+dímero D), modelo ajustado por edad (Wells 2 categorías+dímero D ajustado por edad), algoritmo YEARS. MATERIAL Y MÉTODOS: Estudio retrospectivo de todos los pacientes que se sometieron en nuestro centro a APTC para diagnóstico de EP durante un año. RESULTADOS: De 618 casos (el 85,4% de las APTC) iniciales se incluyeron 544 pacientes. Se diagnosticaron 113 EP (20,8%). El grado de aplicación del modelo estándar fue muy alto (90,1%) y demostró presentar la mejor relación sensibilidad y valor predictivo negativo (sensibilidad=1, valor predictivo negativo=1). Los nuevos modelos podrían reducir el número de exploraciones (17; 3,2% modelo ajustado por edad y 48; 8,8% modelo YEARS) con riesgo de falsos negativos (2 EP [1,8%] no diagnosticadas respectivamente). CONCLUSIONES: Los modelos diagnósticos actuales para EP llevan a la realización de un gran número de exploraciones innecesarias. Los nuevos modelos podrían reducir el número de APTC aunque con un mínimo riesgo de falsos negativos

BACKGROUND: Faced with the suspicion of pulmonary embolism (PE), the guidelines recommend the use of clinical probability scales, measurement of D-dimer and, in certain cases, confirmation by pulmonary angiography by computed tomography (CTPA) or scintigraphy. Recently, it has been proposed to adjust the D-dimer according to age or use simpler scales (YEARS algorithm) for a better selection of patients. OBJECTIVE: To define the degree of application of the guidelines in our population and compare sensitivity, specificity and positive and negative predictive values of the different diagnostic models: Standard model (Wells 2 categories+D-dimer), Model adjusted for age (Wells 2 categories+D-dimer adjusted for age), YEARS algorithm. MATERIAL AND METHODS: A retrospective study of all patients who underwent APTC at our centre for the diagnosis of PE over one year. RESULTS: Of 618 cases (85.4% of initial APTC), 544 patients were included. A total of 113 EPs were diagnosed (20.8%). The degree of application of the standard model was very high (90.1%) and proved to have the best sensitivity and negative predictive value ratio (sensitivity=1.0, negative predictive value=1.0). The new models could reduce the number of scans (17, 3.2% model adjusted for age and 48, 8.8% model YEARS) with a risk of false negatives (2 PE [1.8%] undiagnosed respectively). CONCLUSIONS: The current diagnostic models for PE lead to a large number of unnecessary explorations. The new models could reduce the number of APTC although with a minimum risk of false negatives

Usefulness of predictive models of pulmonary embolism. / Utilidad de los modelos predictivos de embolia pulmonar.

BACKGROUND: Faced with the suspicion of pulmonary embolism (PE), the guidelines recommend the use of clinical probability scales, measurement of D-dimer and, in certain cases, confirmation by pulmonary angiography by computed tomography (CTPA) or scintigraphy. Recently, it has been proposed to adjust the D-dimer according to age or use simpler scales (YEARS algorithm) for a better selection of patients. OBJECTIVE: To define the degree of application of the guidelines in our population and compare sensitivity, specificity and positive and negative predictive values of the different diagnostic models: Standard model (Wells 2 categories+D-dimer), Model adjusted for age (Wells 2 categories+D-dimer adjusted for age), YEARS algorithm. MATERIAL AND METHODS: A retrospective study of all patients who underwent APTC at our centre for the diagnosis of PE over one year. RESULTS: Of 618 cases (85.4% of initial APTC), 544 patients were included. A total of 113 EPs were diagnosed (20.8%). The degree of application of the standard model was very high (90.1%) and proved to have the best sensitivity and negative predictive value ratio (sensitivity=1.0, negative predictive value=1.0). The new models could reduce the number of scans (17, 3.2% model adjusted for age and 48, 8.8% model YEARS) with a risk of false negatives (2 PE [1.8%] undiagnosed respectively). CONCLUSIONS: The current diagnostic models for PE lead to a large number of unnecessary explorations. The new models could reduce the number of APTC although with a minimum risk of false negatives.

Infiltrado pulmonar unilateral: una forma rara de presentación de un linfoma pulmonar primario / Unilateral lung infiltrate: A rare form of presentation of primary pulmonary lymphoma

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