폐색전증이 의심된 환자에서 두 가지 폐색전증 진단 예측 모형의 평가

Other Titles
Assessment of Two Clinical Prediction Models for a Pulmonary Embolism in Patients with a Suspected Pulmonary Embolism
Authors
박재석최원일민보람박지혜채진녕전영준유호정김지영김경주고성민
Department
Dept. of Internal Medicine (내과학); Dept. of Radiology (영상의학)
Issue Date
2008
Citation
결핵 및 호흡기 질환, Vol.64(4) : 266-271, 2008
ISSN
1738-3536
Abstract
Background: Estimation of the probability of a patient having an acute pulmonary embolism (PE) for patients with a suspected PE are well established in North America and Europe. However, an assessment of the prediction rules for a PE has not been clearly defined in Korea. The aim of this study is to assess the prediction rules for patients with a suspected PE in Korea. Methods: We performed a retrospective study of 210 inpatients or patients that visited the emergency ward with a suspected PE where computed tomography pulmonary angiography was performed at a single institution between January 2005 and March 2007. Simplified Wells rules and revised Geneva rules were used to estimate the clinical probability of a PE based on information from medical records. Results: Of the 210 patients with a suspected PE, 49 (19.5%) patients had an actual diagnosis of a PE. The proportion of patients classified by Wells rules and the Geneva rules had a low probability of 1% and 21%, an intermediate probability of 62.5% and 76.2%, and a high probability of 33.8% and 2.8%, respectively. The prevalence of PE patients with a low, intermediate and high probability categorized by the Wells rules and Geneva rules was 100% and 4.5% in the low range, 18.2% and 22.5% in the intermediate range, and 19.7% and 50% in the high range, respectively. Receiver operating characteristic curve analysis showed that the revised Geneva rules had a higher accuracy than the Wells rules in terms of detecting PE. Concordance between the two prediction rules was poor (κ coefficient=0.06). Conclusion: In the present study, the two prediction rules had a different predictive accuracy for pulmonary embolisms. Applying the revised Geneva rules to inpatients and emergency ward patients suspected of having PE may allow a more effective diagnostic process than the use of the Wells rules. (Tuberc Respir Dis 2008;64: 266-271) Key Words: Pulmonary embolism, Diagnosis, Computed tomography
연구배경: 급성 폐색전증의 발생을 예측하는 Wells 및 Geneva 예측 모형은 서구에서 잘 확립되어 있다. 폐색전 증의 역학이 서구와 다를 것으로 보이는 국내에서의 예측 모형의 유용성에 대해서 평가 하고자 한다. 방 법: 단일 의료기관에서 폐색전증 의심 하에 multidetector computed tomography (MDCT)를 시행한 환자 210명을 대상으로 후향적으로 조사하였다. 성별 구성은 남자 90명(42.9%), 여자 120명(57.1%)이었고, 평균 연령 은 63.3±15.9세였다. 의무기록을 바탕으로 Wells 및 개정 된 Geneva 예측 모형으로 폐색전증의 가능성에 대해 저 위험군, 중등도 위험군, 고위험군으로 분류하였다. 결 과: 폐색전증으로 진단된 환자는 210명 중 41명 (19.5%)이었다. Wells 예측 모형을 적용한 폐색전증 발병 가능성 평가에서는, 2명(1%)이 저위험군, 137명(62.5%) 이 중등도 위험군, 71명(33.8%)이 고위험군으로 분류되었 고, 각 군에서 폐색전증의 발생률은 100%, 18.2%, 19.7%271 였다. 개정된 Geneva 예측 모형을 적용할 경우 44명(21%) 이 저위험군, 160명(76.2%)이 중등도 위험군, 6명(2.8%)이 고위험군으로 분류되었고, 각 군에서 폐색전증의 발생률은 4.5%, 22.5%, 50%로 나타났다. Receiver operating characteristic (ROC) 곡선 분석에서 개정된 Geneva 예측 모형이 Wells 예측 모형에 비해 정확도가 높았다. 두 예측 모형 사 이의 일치율은 불량했다(κ coefficient=0.06). 결 론: 본 연구에서는 폐색전증이 의심되는 환자에서 개정된 Geneva 예측모형과 Wells 예측 모형으로 평가하 여 두 모형 사이에 일치율이 불량하였으며, 개정된 Geneva 모형이 Wells 모형에 비해 폐색전증 진단 예측이 더 정확 하였다.
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/37335
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Radiology (영상의학)
Keimyung Author(s)
박재석; 최원일; 전영준; 고성민
File in this Item
oak-bbb-00138.pdf(277.53 kB)Download
Export
RIS (EndNote)
XLS (Excel)
XML


qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

BROWSE