Article Figures & Data
Figures
Tables
Supplemental Figure and Table
Supplemental Figure 1- Visual Analogue Scale used to estimate "gestalt;" Supplemental Table 1- Overview of items of the original Wells PE rule
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- Supplemental data: Figure & Table - PDF file
The Article in Brief
Ruling Out Pulmonary Embolism in Primary Care: Comparison of the Diagnostic Performance of "Gestalt" and the Wells Rule
Janneke Hendriksen , and colleagues
Background Formal prediction models are often considered a more accurate way to estimate the probability of disease compared with a physician?s intuitive estimate ("gestalt"). Standardized prediction models, however, do not allow for consideration of individual patient characteristics. The aim of this paper is to compare the diagnostic performance of gestalt and the Wells decision rule for safely and efficiently ruling out pulmonary embolism (PE) in primary care.
What This Study Found Among 598 adult patients with suspected PE, both gestalt and the Wells rule were safe for ruling out PE when combined with D-dimer testing, however the Wells rule was more efficient at ruling out PE in a larger proportion of patients. While family physicians were very capable of identifying patients at both ends of the probability spectrum, for a large group of patients at intermediate risk, application of the Wells rule and D-dimer testing optimized risk stratification better than using gestalt alone.
Implications
- These findings, the authors conclude, support the use of a prediction model, but leave room for relying on gestalt if disease presence or absence is highly likely or unlikely.