{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T16:35:10Z","timestamp":1793982910088,"version":"4.8.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"32","license":[{"start":{"date-parts":[[2023,7,15]],"date-time":"2023-07-15T00:00:00Z","timestamp":1689379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003246","name":"Dutch Research Council","doi-asserted-by":"publisher","award":["91719304"],"award-info":[{"award-number":["91719304"]}],"id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Risk stratification is used for decisions regarding need for imaging in patients with clinically suspected acute pulmonary embolism (PE). The aim was to develop a clinical prediction model that provides an individualized, accurate probability estimate for the presence of acute PE in patients with suspected disease based on readily available clinical items and D-dimer concentrations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>An individual patient data meta-analysis was performed based on sixteen cross-sectional or prospective studies with data from 28 305 adult patients with clinically suspected PE from various clinical settings, including primary care, emergency care, hospitalized and nursing home patients. A multilevel logistic regression model was built and validated including ten a priori defined objective candidate predictors to predict objectively confirmed PE at baseline or venous thromboembolism (VTE) during follow-up of 30 to 90 days. Multiple imputation was used for missing data. Backward elimination was performed with a P-value &amp;lt;0.10. Discrimination (c-statistic with 95% confidence intervals [CI] and prediction intervals [PI]) and calibration (outcome:expected [O:E] ratio and calibration plot) were evaluated based on internal-external cross-validation. The accuracy of the model was subsequently compared with algorithms based on the Wells score and D-dimer testing. The final model included age (in years), sex, previous VTE, recent surgery or immobilization, haemoptysis, cancer, clinical signs of deep vein thrombosis, inpatient status, D-dimer (in \u00b5g\/L), and an interaction term between age and D-dimer. The pooled c-statistic was 0.87 (95% CI, 0.85\u20130.89; 95% PI, 0.77\u20130.93) and overall calibration was very good (pooled O:E ratio, 0.99; 95% CI, 0.87\u20131.14; 95% PI, 0.55\u20131.79). The model slightly overestimated VTE probability in the lower range of estimated probabilities. Discrimination of the current model in the validation data sets was better than that of the Wells score combined with a D-dimer threshold based on age (c-statistic 0.73; 95% CI, 0.70\u20130.75) or structured clinical pretest probability (c-statistic 0.79; 95% CI, 0.76\u20130.81).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The present model provides an absolute, individualized probability of PE presence in a broad population of patients with suspected PE, with very good discrimination and calibration. Its clinical utility needs to be evaluated in a prospective management or impact study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>PROSPERO ID 89366.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad417","type":"journal-article","created":{"date-parts":[[2023,6,17]],"date-time":"2023-06-17T12:11:19Z","timestamp":1687003879000},"page":"3073-3081","source":"Crossref","is-referenced-by-count":54,"title":["Diagnostic management of acute pulmonary embolism: a prediction model based on a patient data meta-analysis"],"prefix":"10.1093","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5256-6346","authenticated-orcid":false,"given":"Nick","family":"van Es","sequence":"first","affiliation":[{"name":"Amsterdam University Medical Center, Department of Vascular Medicine, University of Amsterdam, Amsterdam , Meibergdreef 9, 1105 AZ, Amsterdam , The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis , Meibergdreef 9, 1105 AZ, Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiko","family":"Takada","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Universiteitsweg 100, 3584 CG, Utrecht , The Netherlands"},{"name":"Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University , 1 Hikarigaoka, Fukushima, 960-1247 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"No\u00e9mie","family":"Kraaijpoel","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Center, Department of Vascular Medicine, University of Amsterdam, Amsterdam , Meibergdreef 9, 1105 AZ, Amsterdam , The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis , Meibergdreef 9, 1105 AZ, Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederikus A","family":"Klok","sequence":"additional","affiliation":[{"name":"Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center , Albinusdreef 2, 2333 ZA, Leiden, Zuid-Holland , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milou A M","family":"Stals","sequence":"additional","affiliation":[{"name":"Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center , Albinusdreef 2, 2333 ZA, Leiden, Zuid-Holland , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry R","family":"B\u00fcller","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Center, Department of Vascular Medicine, University of Amsterdam, Amsterdam , Meibergdreef 9, 1105 AZ, Amsterdam , The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis , Meibergdreef 9, 1105 AZ, Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D Mark","family":"Courtney","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Texas Southwestern Medical Center , 5323 Harry Hines Blvd, Dallas, TX 75390 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonathan","family":"Freund","sequence":"additional","affiliation":[{"name":"Emergency Department, Sorbonne University, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re, Assistance Publique-H\u00f4pitaux de Paris , 47-83 Bd de l'H\u00f4pital, 75013 Paris , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Galipienzo","sequence":"additional","affiliation":[{"name":"Service of Anesthesiology, MD Anderson Cancer Center Madrid, C. de Arturo Soria , 270, 28033 Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gr\u00e9goire","family":"Le Gal","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute , 725 Parkdale Ave, Ottawa, ON K1Y 4E9 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"Ghanima","sequence":"additional","affiliation":[{"name":"Departments of Hemato-oncology and Research, \u00d8stfold hospital , Kalnesveien 300, 1714 Gr\u00e5lum , Norway"},{"name":"Institute of Clinical Medicine, University of Oslo , Klaus Torg\u00e5rds vei 3, 0372 Oslo, Oslo , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menno V","family":"Huisman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center , Albinusdreef 2, 2333 ZA, Leiden, Zuid-Holland , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A","family":"Kline","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Wayne State University School of Medicine , 540 E Canfield St, Detroit, MI 4820 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel G M","family":"Moons","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Universiteitsweg 100, 3584 CG, Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer","family":"Parpia","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, & Impact, McMaster University , 1200 Main St W, Hamilton, ON L8N 3Z5 , Canada"},{"name":"Department of Oncology, McMaster University, Juravinski Cancer Centre , 699 Concession St. Suite 4-204, Hamilton, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Perrier","sequence":"additional","affiliation":[{"name":"Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine , Rue Michel-Servet 1, 1206 Gen\u00e8ve , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Righini","sequence":"additional","affiliation":[{"name":"Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine , Rue Michel-Servet 1, 1206 Gen\u00e8ve , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helia","family":"Robert-Ebadi","sequence":"additional","affiliation":[{"name":"Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine , Rue Michel-Servet 1, 1206 Gen\u00e8ve , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4811-6793","authenticated-orcid":false,"given":"Pierre-Marie","family":"Roy","sequence":"additional","affiliation":[{"name":"Emergency Department, CHU Angers, UNIV Angers , 4 Rue Larrey, 49100 Angers, Maine-et-Loire , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil S","family":"Wells","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute , 725 Parkdale Ave, Ottawa, ON K1Y 4E9 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"de Wit","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Queen's University , 76 Stuart Street, Kingston ON K7L 2V7 , Canada"},{"name":"Department of Medicine, McMaster University , McMaster Children's Hospital, 1200 Main Street West, Hamilton, L8N 3Z5 Ontario , Canada"},{"name":"Department of Health Evidence and Impact, McMaster University , 1200 Main St W, Hamilton, ON L8N 3Z5 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5529-1541","authenticated-orcid":false,"given":"Maarten","family":"van Smeden","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Universiteitsweg 100, 3584 CG, Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert-Jan","family":"Geersing","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Universiteitsweg 100, 3584 CG, Utrecht , The 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