Outcomes in patients with suspected PE from test accuracy studies
| Pathway* . | Test . | Mortality: all-cause . | Mortality: from PE at 3 mo . | Incidence of PE at 3 mo . | Incidence of DVT at 3 mo . | Overall VTE at 3 mo . | CTEPH . | Major bleeding . | Hemorrhagic stroke . |
|---|---|---|---|---|---|---|---|---|---|
| Anticoagulated (TP/FP population) | |||||||||
| A | Positive CT | 2/107 (1.87%; 95% CI, 0-4.44) | 7/105 (6.67%; 95% CI, 1.89-11.44) | 0/105 (0%) | 0/105 (0%) | 0/105 (0%) | NR | NR | NR |
| L | Positive DD → positive CT | 21/598 (3.51%; 95% CI, 2.04-4.99) | 0/598 (0%) | 0/598 (0%) | 0/598 (0%) | 0/598 (0%) | NR | NR | NR |
| L/A | Low PTP: positive DD → positive CT High PTP: positive CT | 62/853 (7.27%) | 12/853 (1.40%) | 15/853 (1.76%) | 7/853 (0.82%) | 22/853 (2.58%) | NR | 2/180 (1.11%) | NR |
| J | High prob VQ or nondiagnostic VQ → positive CUS | 6/41 (14.6%; 95% CI, 3.82-25.45) | 0/41 (0%) | 0/41 (0%) | 0/41 (0%) | 0/41 (0%) | NR | 0/41 (0%) | NR |
| Not anticoagulated (TN/FN population) | |||||||||
| A | Negative CT (int PTP) | 38/381 (9.97%; 95% CI, 6.96-12.98) | 1/748 (0.13%; 95% CI, 0-0.40) | 1/748 (0.13%; 95% CI, 0-0.40) | 1/748 (0.13%; 95% CI, 0-0.40) | 2/748 (0.27%; 95% CI, 0-0.64) | NR | NR | NR |
| A | Negative CT (high PTP) | 3/325 (0.92%; 95% CI, 0-1.96) | 0/651 (0%) | 8/1302 (0.61%; 95% CI, 0.19-1.04) | 3/1302 (0.23%; 95% CI, 0-0.49) | 11/1302 (0.84%; 95% CI, 0.35-1.34) | NR | NR | NR |
| K | Negative DD (low PTP) | NR | 0/808 (0%) | 4/1094 (0.37%; 95% CI, 0.007-0.72) | 0/808 (0%) | 4/1094 (0.37%; 95% CI, 0.007-0.72) | NR | NR | NR |
| K | Negative DD (int PTP) | 12/2387 (0.50%; 95% CI, 0.22-0.79) | 0/2747 (0%) | 13/3015 (0.43%; 95% CI, 0.20-0.66) | 1/3015 (0.03%; 95% CI, 0-0.12) | 14/3015 (0.46%; 95% CI, 0.22-0.71) | NR | NR | NR |
| K | Negative age-adjusted DD (low/int PTP) | 7/331 (2.11%; 95% CI, 0.56-3.66) | 0/331 (0%) | 1/331 (0.30%; 95% CI, 0-0.89) | 0/331 (0%) | 1/331 (0.30%; 95% CI, 0-0.89) | NR | NR | NR |
| L | Positive DD → negative CT (int PTP) | NR | 2/294 (0.68%; 95% CI, 0-1.62) | 3/294 (1.02%; 95% CI, 0-2.17) | 2/294 (0.68%; 95% CI, 0-1.62) | 5/294 (1.70%; 95% CI, 0.22-3.18) | NR | NR | NR |
| L | Positive age-adjusted DD → negative CT (int PTP) | 17/1243 (1.37%; 95% CI, 0.72-2.01) | 0/1243 (0%) | 6/1243 (0.48%; 95% CI, 0.10-0.87) | 0/1243 (0%) | 6/1243 (0.48%; 95% CI, 0.10-0.87) | NR | NR | NR |
| L/A | Low PTP: positive DD → negative CT High PTP: negative CT | 162/2566 (6.31%; 95% CI, 5.37-7.25) | 8/2497 (0.32%; 95% CI, 0.10-54) | 13/2486 (0.52%; 95% CI, 0.24-0.81) | 14/2486 (0.56%; 95% CI, 0.27-0.86) | 27/2486 (1.09%; 95% CI, 0.68-1.49) | NR | 1/627 (0.16%; 95% CI, 0-0.47) | NR |
| J/N | Low PTP: negative DD High PTP or positive DD: normal VQ scan or nondiagnostic → negative US | NR | 0/95 (0%) | 0/95 (0%) | 0/95 (0%) | 0/95 (0%) | NR | NR | NR |
| J | Normal VQ scan or nondiagnostic → negative US (int PTP) | 5/73 (6.85%; 95% CI, 1.05-12.64) | 0/73 (0%) | 9/82 (10.98%; 95% CI, 4.21-17.74) | 0/82 (0%) | 9/82 (10.98%; 95% CI, 4.21-17.74) | NR | NR | NR |
| I/J | Normal VQ scan (int PTP) | NR | NR | 4/354 (1.13%; 95% CI, 0.03-2.23) | 0/354 (0%) | 4/354 (1.13%; 95% CI, 0.03-2.23) | NR | NR | NR |
| Positive DD → normal VQ | NR | 0/144 (0%) | 1/144 (0.69%; 95% CI, 0-2.05) | 1/144 (0.69%; 95% CI, 0-2.05) | 2/144 (1.39%; 95% CI, 0-3.30) | NR | NR | NR | |
| I/J | Nonhigh VQ scan (no follow-up test, int PTP) | NR | NR | 64/737 (8.68%; 95% CI, 6.65-10.72) | 0/737 (0%) | 64/737 (8.68%; 95% CI, 6.65-10.72) | NR | NR | NR |
| Pathway* . | Test . | Mortality: all-cause . | Mortality: from PE at 3 mo . | Incidence of PE at 3 mo . | Incidence of DVT at 3 mo . | Overall VTE at 3 mo . | CTEPH . | Major bleeding . | Hemorrhagic stroke . |
|---|---|---|---|---|---|---|---|---|---|
| Anticoagulated (TP/FP population) | |||||||||
| A | Positive CT | 2/107 (1.87%; 95% CI, 0-4.44) | 7/105 (6.67%; 95% CI, 1.89-11.44) | 0/105 (0%) | 0/105 (0%) | 0/105 (0%) | NR | NR | NR |
| L | Positive DD → positive CT | 21/598 (3.51%; 95% CI, 2.04-4.99) | 0/598 (0%) | 0/598 (0%) | 0/598 (0%) | 0/598 (0%) | NR | NR | NR |
| L/A | Low PTP: positive DD → positive CT High PTP: positive CT | 62/853 (7.27%) | 12/853 (1.40%) | 15/853 (1.76%) | 7/853 (0.82%) | 22/853 (2.58%) | NR | 2/180 (1.11%) | NR |
| J | High prob VQ or nondiagnostic VQ → positive CUS | 6/41 (14.6%; 95% CI, 3.82-25.45) | 0/41 (0%) | 0/41 (0%) | 0/41 (0%) | 0/41 (0%) | NR | 0/41 (0%) | NR |
| Not anticoagulated (TN/FN population) | |||||||||
| A | Negative CT (int PTP) | 38/381 (9.97%; 95% CI, 6.96-12.98) | 1/748 (0.13%; 95% CI, 0-0.40) | 1/748 (0.13%; 95% CI, 0-0.40) | 1/748 (0.13%; 95% CI, 0-0.40) | 2/748 (0.27%; 95% CI, 0-0.64) | NR | NR | NR |
| A | Negative CT (high PTP) | 3/325 (0.92%; 95% CI, 0-1.96) | 0/651 (0%) | 8/1302 (0.61%; 95% CI, 0.19-1.04) | 3/1302 (0.23%; 95% CI, 0-0.49) | 11/1302 (0.84%; 95% CI, 0.35-1.34) | NR | NR | NR |
| K | Negative DD (low PTP) | NR | 0/808 (0%) | 4/1094 (0.37%; 95% CI, 0.007-0.72) | 0/808 (0%) | 4/1094 (0.37%; 95% CI, 0.007-0.72) | NR | NR | NR |
| K | Negative DD (int PTP) | 12/2387 (0.50%; 95% CI, 0.22-0.79) | 0/2747 (0%) | 13/3015 (0.43%; 95% CI, 0.20-0.66) | 1/3015 (0.03%; 95% CI, 0-0.12) | 14/3015 (0.46%; 95% CI, 0.22-0.71) | NR | NR | NR |
| K | Negative age-adjusted DD (low/int PTP) | 7/331 (2.11%; 95% CI, 0.56-3.66) | 0/331 (0%) | 1/331 (0.30%; 95% CI, 0-0.89) | 0/331 (0%) | 1/331 (0.30%; 95% CI, 0-0.89) | NR | NR | NR |
| L | Positive DD → negative CT (int PTP) | NR | 2/294 (0.68%; 95% CI, 0-1.62) | 3/294 (1.02%; 95% CI, 0-2.17) | 2/294 (0.68%; 95% CI, 0-1.62) | 5/294 (1.70%; 95% CI, 0.22-3.18) | NR | NR | NR |
| L | Positive age-adjusted DD → negative CT (int PTP) | 17/1243 (1.37%; 95% CI, 0.72-2.01) | 0/1243 (0%) | 6/1243 (0.48%; 95% CI, 0.10-0.87) | 0/1243 (0%) | 6/1243 (0.48%; 95% CI, 0.10-0.87) | NR | NR | NR |
| L/A | Low PTP: positive DD → negative CT High PTP: negative CT | 162/2566 (6.31%; 95% CI, 5.37-7.25) | 8/2497 (0.32%; 95% CI, 0.10-54) | 13/2486 (0.52%; 95% CI, 0.24-0.81) | 14/2486 (0.56%; 95% CI, 0.27-0.86) | 27/2486 (1.09%; 95% CI, 0.68-1.49) | NR | 1/627 (0.16%; 95% CI, 0-0.47) | NR |
| J/N | Low PTP: negative DD High PTP or positive DD: normal VQ scan or nondiagnostic → negative US | NR | 0/95 (0%) | 0/95 (0%) | 0/95 (0%) | 0/95 (0%) | NR | NR | NR |
| J | Normal VQ scan or nondiagnostic → negative US (int PTP) | 5/73 (6.85%; 95% CI, 1.05-12.64) | 0/73 (0%) | 9/82 (10.98%; 95% CI, 4.21-17.74) | 0/82 (0%) | 9/82 (10.98%; 95% CI, 4.21-17.74) | NR | NR | NR |
| I/J | Normal VQ scan (int PTP) | NR | NR | 4/354 (1.13%; 95% CI, 0.03-2.23) | 0/354 (0%) | 4/354 (1.13%; 95% CI, 0.03-2.23) | NR | NR | NR |
| Positive DD → normal VQ | NR | 0/144 (0%) | 1/144 (0.69%; 95% CI, 0-2.05) | 1/144 (0.69%; 95% CI, 0-2.05) | 2/144 (1.39%; 95% CI, 0-3.30) | NR | NR | NR | |
| I/J | Nonhigh VQ scan (no follow-up test, int PTP) | NR | NR | 64/737 (8.68%; 95% CI, 6.65-10.72) | 0/737 (0%) | 64/737 (8.68%; 95% CI, 6.65-10.72) | NR | NR | NR |
Data are from 22 studies11-32 with 15 865 patients.
DD, D-dimer; int, intermediate; NR, not reported; prob, probability.
Pathways (denoted by letters) with diagrams are in supplemental Material 1.