ABSTRACT
The authors question whether the d-dimer assay and pulmonary computed tomography angiography (CTA) are being used appropriately to evaluate suspected acute pulmonary embolism (PE) at their hospital. To answer this question, a retrospective review was performed on all emergency department (ED) patients who underwent d-dimer assay and/or CTA from August 15, 2008, to August 14, 2009. The authors' algorithm for diagnosing PE requires that patients with low or intermediate probability of acute PE undergo a d-dimer assay, followed by CTA if the d-dimer is positive. Patients with high probability of PE should have CTA performed without a d-dimer assay. This result suggests that d-dimer assay and CTA are used inappropriately to evaluate patients with suspected acute PE in our ED. The low threshold for initiating an evaluation for PE decreases the prevalence of PE in this population.
Subject(s)
Algorithms , Fibrin Fibrinogen Degradation Products , Lung/diagnostic imaging , Pulmonary Embolism/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Angiography , Female , Hospital Bed Capacity, 300 to 499 , Hospitals, Teaching , Hospitals, Urban , Humans , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed , Young AdultABSTRACT
Observations of changes in the properties of ocean waters have been restricted to surface or intermediate-depth waters, because the detection of change in bottom water is extremely difficult owing to the small magnitude of the expected signals. Nevertheless, temporal changes in the properties of such deep waters across an ocean basin are of particular interest, as they can be used to constrain the transport of water at the bottom of the ocean and to detect changes in the global thermohaline circulation. Here we present a comparison of a trans-Pacific survey completed in 1985 (refs 4, 5) and its repetition in 1999 (ref. 6). We find that the deepest waters of the North Pacific Ocean have warmed significantly across the entire width of the ocean basin. Our observations imply that changes in water properties are now detectable in water masses that have long been insulated from heat exchange with the atmosphere.
