A Simple Clinical Model Composed of ECG, Shock Index, and Arterial Blood Gas Analysis for Predicting Severe Pulmonary Embolism

Abstract

Adding the scores obtained from SI and ABG to the sECG enhances the specificity of sECG in predicting RVD (+) or severe PE patients, although a lesser degree decreasing in sensitivity may occur.

Accuracy of D-dimer : fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units : cardiovascular topic

“…These results confirm other studies that showed arterial blood gas or its combination with other data could not be used to detect PTE, and if used alone, may lower the sensitivity and specificity 20,21…”

The Value of Electrocardiographic Abnormalities in the Prognosis of Pulmonary Embolism: A Consensus Paper

“…19 Furthermore, sinus tachycardia may be more common in patients with acute PE than chronic PE (74% vs 51%, P = 0007), 45 as well as in pulmonary trunk embolism than peripheral embolism (100% vs 30%), though statistical significance was not calculated for the latter. 46 In terms of prognostication, sinus tachycardia has been shown to be more prevalent in patients with massive PE than nonmassive PE in one study (36% vs 0%), 37 but this finding was not replicated by Bircan et al 42 While some studies have shown that patients with sinus tachycardia are at increased risk of in-hospital complications (88% vs 19%, P = 0.0003; 65% vs 38%, P < 0.05) 38,41 and in-hospital death (91% vs 37%, P < 0.001), 41 several studies have found no significant association with either, 23,38,45 , nor with degree of cardiac biomarker elevation. 47 It appears as though more studies have assessed the prognostic role of atrial arrhythmias and tachycardia "not-further-specified" in the setting of PE rather than sinus tachycardia alone.…”

“…Sinus tachycardia has been found to be more common in patients with RVD than those without RVD (50% vs 16%, P = 0.012; 55% vs 29%, P < 0.05; 58% vs 21%, P = 0.002), 15,41,44 but was not found to be significant in multivariate logistic regression analysis, 44 and only a trend toward significance was found by Bircan et al (69% vs 31%, P = NS). 42 Sinus tachycardia has also been found to be more common in patients with RV enlargement than those without (29% vs 18%, P = 0.02). 19 Furthermore, sinus tachycardia may be more common in patients with acute PE than chronic PE (74% vs 51%, P = 0007), 45 as well as in pulmonary trunk embolism than peripheral embolism (100% vs 30%), though statistical significance was not calculated for the latter.…”

“…Bircan et al combined the ECG scoring system with arterial blood gas (ABG) analysis and shock index in predicting severe PE and found that the combination of scores enhanced the specificity of the ECG score in predicting RVD or severe PE patients (73.7% combined score vs 52.6% 21-point ECG alone), at the expense of sensitivity (58.8% combined score vs 70.6% ECG alone). 42 Another study by Kline et al found that a panel of tests including pulse oximetry, ECG score, and serum troponin measurement had an overall prognostic utility that was equivalent to echocardiography for prediction of a poor outcome from PE in normotensive patients, though an ECG score >8 had the highest specificity and positive predictive value (100% each). 43 In recent years, there have been several studies that have provided further information on the utility of common ECG abnormalities in the prognostic assessment of PE.…”

Age- and sex-specific normal values for shock index in National Health and Nutrition Examination Survey 1999-2008 for ages 8 years and older

“…Shock index (SI), the ratio of heart rate to systolic blood pressure, has been found to predict shock in both settings, primarily in adult populations. Elevated SI, even in the context of normal systolic blood pressure, is associated with shock in multiple conditions including trauma [1][2][3][4], pulmonary embolism [5], pneumonia [6], and ectopic pregnancy [7][8][9]. Elevated SI has also been shown to predict mortality [2,6,10,11] and need for critical care [10,[12][13][14][15][16] in adults.…”