TAC en baixa sospita de TEP!
Font original: Urgències i Emergències mèdiques
Evitar el TAC pulmonar en pacients d’urgències amb una baixa probabilitat de TEP (segons l’escala de Wells o la Revised Geneva score), i que a més, tinguin un dímer-d negatiu o siguin pacients amb un PERC negatiu.
- Criteris de Wells pel diagnòstic de TEP: es considera una baixa probabilitat de TEP quan aquesta és < 12,1 % o 0-4 punts. Enllaç a la calculadora
- Revised Geneva Score (rGeneva): es considera baixa probabilitat de TEP quan aquesta és del < 10 % o 0-3 punts. Enllaç a la calculadora
- PERC Rule for Pulmonary Embolism: aplicable només en població amb < 15 % de probabilitat de TEP, segons Wells o rGeneva. Si en aquesta població el PERC és negatiu, la probabilitat de TEP és < 2 %. Enllaç a la calculadora
- Dímer-d: un Dimer-d negatiu aplicat a una població amb baix risc de TEP, segons Wells o rGeneva, genera una probabilitat de TEP del 1 %.
El sobrecost econòmic i els possibles efectes nocius (exposició a radiacions ionitzants i el risc de detectar i tractar embòlies pulmonars clínicament insignificants amb anticoagulants) fa que el TAC només tingui utilitat per descartar o confirmar un TEP en pacients amb moderada o alta probabilitat pre-prova. L’ús d’aquestes eines de decisió clínica ajuden a reduir un 30 % les indicacions de TAC.
Iniciatives
- Royal Australian and New Zealand College of Radiologists. link
- American College of Emergency Physicians. link
- American College of Chest Physicians and American Thoracic Society. link
- American College of Radiology. link
- Less Is More Collection – JAMA Network. link
Bibliografia
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