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Cover Page

The handle

http://hdl.handle.net/1887/79518

holds various files of this Leiden University

dissertation.

Author: Pol, L.M. van der

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ImprovIng effIcIency

of the dIagnostIc management of pulmonary embolIsm

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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanic, photocopying, and recording or otherwise, without prior written by the author.

ISBN: 978-94-6361-299-9

Cover image: Annette Offereins-Dijkhuizen

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ImprovIng effIcIency

of the dIagnostIc management of pulmonary embolIsm

Proefschrift

Ter verkrijging van de graad van Doctor aan de Universiteit van Leiden, op gezag van Rector Magnificus prof. Mr. C.J.J.M. Stolker,

volgens het besluit van het College voor Promoties te verdedigen op woensdag 16 oktober 2019

klokke 11.15 uur door

Liselotte Myrthe van der Pol geboren te Dirksland

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Prof. dr. M.V. Huisman Co-promotores Dr. F.A. Klok

Dr. A.T.A. Mairuhu (HagaZiekenhuis, Den Haag) Overige commissieleden

Prof. Dr. H. ten Cate (Maastricht Universitair Medisch Centrum, Maastricht) Prof. Dr. H.C.J. Eikenboom

Prof. Dr. F.W.G. Leebeek (Erasmus Medisch Centrum, Rotterdam) Prof. Dr. J.E.A. Portielje

Financial support was kindly provided by Chipsoft, Boehringer-Ingelheim BV,

LEO Pharma B.V., @DigitalMedDoc, Federatie van Nederlandse Trombosediensten, Stago BNL, HagaZiekenhuis te Den Haag.

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table of contents

PART I The diagnostic management of suspected PE in pregnancy

Chapter 1 General introduction 7

Chapter 2 Use of clinical prediction rules and D-dimer tests in the diagnostic management of pregnant patients with suspected pulmonary embolism

13

Chapter 3 Computed tomography pulmonary angiography versus ventilation-perfusion lung scan for pulmonary embolism diagnosis during pregnancy: a systematic review and meta-analysis

29

Chapter 4 Diagnostic management of suspected pulmonary embolism during pregnancy – The Artemis study

51

PART II The diagnostic management of suspected PE in unselected patients Chapter 5 Sex-specific performance of pre-imaging diagnostic algorithms for

pulmonary embolism

67 Chapter 6 No added value of the age-adjusted D-dimer cut-off to the YEARS

algorithm in patients with suspected pulmonary embolism

83 Chapter 7 Combination of pulmonary embolism rule-out criteria (PERC) and

YEARS algorithm in a European cohort of patients with suspected pulmonary embolism

99

Chapter 8 The YEARS algorithm for suspected pulmonary embolism: Shorter visit time and reduced costs at the Emergency department

113 Chapter 9 Chest X-ray not routinely indicated prior to the YEARS algorithm, in

the diagnostic management of suspected pulmonary embolism

129 Chapter 10 Lower prevalence of subsegmental pulmonary embolism after

application of the YEARS diagnostic algorithm

141

Chapter 11 General discussion and summary 155

Chapter 12 Nederlandse samenvatting 165

APPENDICES

List of publications 175

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