Évaluation du score PERC et de l'algorithme YEARS dans le diagnostic de l'embolie pulmonaire : étude rétrospective aux urgences du CHU de Caen

Abstract : The diagnostic strategy for pulmonary embolism is actually well established in the different Emergency services and lie on the evaluation of clinical probability, followed by the dosing of D-Dimer, and finally by the results of an angioscan of the thorax. However, these algorithms are often misused, leading to complementary tests being requested. The goal of this study is to evaluate the validity of the PERC Rule and the YEARS algorithm over a sample of our patients population from the CHU of Caen’s Emergency services, and to compare it to our usual strategy in establishing diagnostic. Method: Single institution study, retrospective, observational, including 1000 patients having received a D-Dimer dosage in the CHU of Caen’s Emergency services from the 1st of June 2017 to the 7th of October 2017. Results: For the YEARS algorithm, out of a total 738 patients, 198 angioscans were performed. Out of the 198 scans, 50 were considered irrelevant as they didn’t display the diagnostic criteria YEARS. In fact, no pulmonary embolisms were made evident on these scans. For the PERC Rule, 185 angioscans scans were performed, of which 16 on patients with a PERC score of 0; no pulmonary embolisms were detected. Discussion: Their use is not to diagnose pulmonary embolisms, but rather, with higher specificities compared to our conventional strategy, they can further detect false positives, preventing the prescription of additional examinations and particularly of unnecessary angioscans. Conclusion: We noted that the results leaned towards the same direction as those of leading studies, and that these new tools seemed better performing than the measures taken during our usual diagnostics.
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Master Thesis
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Julie Robert. Évaluation du score PERC et de l'algorithme YEARS dans le diagnostic de l'embolie pulmonaire : étude rétrospective aux urgences du CHU de Caen. Médecine humaine et pathologie. 2018. ⟨dumas-02048702⟩

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