Acute pulmonary embolism: Appropriateness of emergency department management according to clinical guidelines

Ramos‐Bossini, Antonio Jesús Láinez; Moreno-Suárez, S.; Pérez‐García, Miguel; Gálvez-López, R.; Sanz, F. Garrido; Rivera-Izquierdo, Mario

doi:10.1016/j.rxeng.2020.06.006

Cited by 2 publications

(3 citation statements)

References 30 publications

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“…Acute pulmonary embolism (PE) is a potentially lifethreatening condition which mandates urgent diagnosis and treatment [1]. It is the third leading cause of cardiovascular mortality in emergency departments (EDs) worldwide, following acute myocardial infarction and stroke [2]. Its incidence in the population ranges from 0.5 to 1 per 1000 individuals per year, with no significant sex differences, and increases with age [3].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, the 'old standard' technique for the diagnosis of PE is computed tomography pulmonary angiography (CTPA), which has high sensitivity and specificity, allowing to detect even small (i.e., subsegmental) embolisms. In addition, this technique may show radiological signs associated with right ventricle strain and pulmonary hypertension (RVS/PH), which have been associated with a worse prognosis [2]. For these reasons, CTPA has been suggested to have a fundamental role in the diagnostic work-up of COVID-19 patients for the diagnosis of acute PE [20].…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, some institutions carried out universal CTPA screening to rule out PE, which has been associated with an increased incidence of PE [21]. This increase in the number of CTPAs performed may have magnified the actual incidence of PE by increasing the detection of subsegmental PEs, which are frequently asymptomatic and whose clinical impact is still unclear [2]. Conversely, the number of CTPAs could have been very infrequent in some settings, particularly during the first waves of the pandemic, due to factors such as scarcity of resources, fear to concerns pertaining to the contamination of computed tomography (CT) scanners and inhospital transmission of disease [22], the decrease in patient visits to the ED, or differences in respiratory severity of the disease.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain

2022

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Several studies have been published showing a significant increase in thrombotic complications in coronavirus disease 2019 (COVID-19) patients, including acute pulmonary embolism (PE). However, there is significant variability regarding published data on the number of computed tomography pulmonary angiography (CTPA) orders to rule out PE, frequency and characteristics of PE, and other factors that could have magnified the actual incidence of PE. The aim of this work is to analyze these factors during the first year of the pandemic. A longitudinal retrospective observational study was designed comparing two cohorts (preCOVID and COVID) of patients for whom an emergency CTPA was requested to rule out PE at the emergency department of our institution. Information was collected regarding the number of CTPAs requested, patient demographics, presence and extension of PE, and radiological signs of right ventricle strain/pulmonary hypertension (RVS/PH). Univariate and bivariate analyses were performed, with stratification by time intervals according to different pandemic waves in the COVID cohort. A total of 1905 patients (530 in the pre-COVID cohort and 1375 in the COVID cohort), with a mean age of 68.3 years (standard deviation, 16.5) and 981 (51.5%) women were included. No significant differences were observed regarding the incidence of PE between both cohorts. In patients with PE, no significant differences regarding age or sex were found, but a significantly higher frequency of peripheral PE was observed in the COVID cohort (42.0% vs. 6.5%, p < 0.001). Regarding signs of RVS/PH, a lower degree of septal deviation and contrast reflux to the inferior vena cava was observed in the COVID cohort, but no significant differences were observed in the right-to-left ventricular ratio. For the COVID cohort, the distribution of central vs. peripheral PE was similar in patients without laboratory-confirmed COVID-19 infection. Finally, the analysis of signs of RVS/PH stratifying by pandemic waves showed a lower frequency of RVS/PH signs in the 2nd and 3rd pandemic waves. In conclusion, despite a significantly higher number of CTPAs were performed during the pandemic, the incidence of PE was similar to that of the pre-pandemic period. A higher number of peripheral PE and less radiological signs of RVS/PH were observed during the pandemic. These findings could be explained by an increased incidental detection of PE during the pandemic. Our study has some limitations, mainly derived from its retrospective and single-center nature, which should be overcome in future research.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain

2022

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(Pulmonary embolism in the Tábor region - revised Geneva score and other predictors of PE on CT pulmonary angiogram)

Adámek,

Kuchař

2024

Cor Vasa

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Cí l: Analýza dat ze souboru nemocných vyšetřených pro klinické podezření na plicní embolii (PE) pomocí CT angiografi e plicnice (CTPA) v Nemocnici Tábor za jeden rok od března 2019 do února 2020. Zhodnocení užitečnosti revidovaného ženevského skóre (RGS) v tomto souboru. Metodika: Retrospektivní analýza souboru dat všech pacientů, u nichž byla v období od března 2019 do února 2020 na Radiologickém oddělení Nemocnice Tábor provedena CTPA pro klinické podezření na PE. Byla vypočtena hodnota RGS a byla srovnána se známými výsledky CTPA. Dále byly analyzovány další klinické a laboratorní parametry a jejich užitečnost v predikci výskytu plicní embolie na CTPA. Výsledky: Celkem bylo do souboru zařazeno 584 konsekutivních pacientů, z nichž 3 byli vyřazeni pro chybějící údaje. PE byla zjištěna u 132 (22,60 %) pacientů (71 mužů, 53,8 %); odpovídá při počtu obyvatel 102 451 v roce 2019 1 incidenci necelých 129/100 000. Nízká pravděpodobnost přítomnosti PE dle RGS byla vypočtena u 37,2 % pacientů, střední u 62,5 %, vysoká u 0,3 % nemocných. Nejčastějším symptomem, pro který pacient vyhledal lékařskou pomoc, byla dušnost (342; 58 %). RGS dosahovalo v tomto souboru plochy pod křivkou (AUC) 0,64. V multivariační analýze byly prediktory výskytu plicní embolie na CTPA v daném souboru hodnota ženevského skóre (poměr šancí [OR] 1,27 za bod, p < 0,001) a D-dimerů (OR 1,19 za μg/l, p < 0,001), dále mužské pohlaví (OR 1,99, p = 0,031) a jako negativní prediktor ischemické choroby srdeční (ICHS) v anamnéze (OR 0,31, p = 0,027). Ani kombinovaný model vytvořený z klinických a paraklinických proměnných nestačí, aby nahradil provedení CTPA (AUC 0,78). Zá vě r: Incidence PE v našem souboru je na horní hranici běžně udávané a současně potvrzuje trend narůstající incidence PE v čase. Užitečnost RGS v populaci, kde je již rozhodnuto provést CTPA, je poměrně nízká a ani společně s hodnotou D-dimerů nestačí k nahrazení CTPA.

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Acute pulmonary embolism: Appropriateness of emergency department management according to clinical guidelines

Cited by 2 publications

References 30 publications

Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain

Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain

(Pulmonary embolism in the Tábor region - revised Geneva score and other predictors of PE on CT pulmonary angiogram)

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