Assessment of the pulmonary embolism rule-out criteria rule for evaluation of suspected pulmonary embolism in the emergency department

Wolf, Stephen J.; McCubbin, Tracy; Nordenholz, Kristen E.; Naviaux, N.; Haukoos, Jason S.

doi:10.1016/j.ajem.2007.04.026

Cited by 66 publications

(50 citation statements)

References 13 publications

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“…The 8 variables were (1) age ,50 years; (2) initial heart rate was ,100 beats per minutes; (3) initial oxygen saturation was .94% in room air; (4) no asymmetric lower leg swelling was present; (5) no hemoptysis was reported; (6) no recent surgery was reported; (7) no previous PE or DVT; and (8) no hormone use. 7,8 There are no such tools for pediatric patients. Lack of similar validated criteria combined with lower clinical suspicion may be a partial explanation for the delay in diagnosis in pediatric patients.…”

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confidence: 99%

Pulmonary Embolism in the Pediatric Emergency Department

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Pulmonary embolism (PE) in the pediatric population is rare but does occur and is underrecognized. In adult emergency medicine, there are validated clinical decision rules derived to provide reliable and reproducible means of determining pretest probability of PE. WHAT THIS STUDY ADDS:There are known risk factors, signs, and symptoms that should raise the clinician' s suspicion of pulmonary embolism, even in the pediatric population. abstract OBJECTIVE: To describe patients who present to the pediatric emergency department (PED) and are subsequently diagnosed with pulmonary embolism (PE). METHODS:Electronic medical records from 2003 to 2011 of a tertiary care pediatric health care system was retrospectively reviewed to identify patients ,21 years who had a final International Classification of Diseases, Ninth Revision diagnosis of PE. Patient demographics, and hospital course were recorded. Adult validated clinical decision rules Wells criteria and Pulmonary Embolism Rule-out Criteria (PERC) were retrospectively applied. PERC identified 8 clinical criteria for adult patients using logistic regression modeling to exclude PE without additional diagnostic evaluation. If all criteria are met, further evaluation is not indicated. RESULTS:Of 1 185 794 PED visits, 105 patients had an ultimate diagnosis of PE. Twenty-five met study criteria, and all were admitted. Forty percent of these patients had PE diagnosed in the PED. The most common risk factors were BMI $25 (50%, 10 of 20), oral contraceptive use (38% 5 of 13 female patients), and history of previous thrombus without PE (28%, 7 of 25). When the PERC rule was applied retrospectively, 84% of patients could not be ruled out, indicating additional evaluation for PE was needed.CONCLUSIONS: Pulmonary embolism is rare in children but does occur. This study emphasizes risk factors among children that should raise the suspicion of PE. Additional studies are needed to further evaluate risk factors and signs and symptoms of PE to develop pediatric specific clinical decision rules to provide reliable and reproducible means of determining pretest probability of PE. Pediatrics

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confidence: 99%

Pulmonary Embolism in the Pediatric Emergency Department

et al. 2013

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“…Aunque estos criterios han sido validados en otros estudios (15,16), es importante resaltar que solo deben ser utilizados en los servicios de urgencias y en pacientes con baja prevalencia de PE (< 15 %), ya que en otros contextos y en poblaciones con alta prevalencia de PE (> 15 %), los PERC solos o en combinación con el puntaje de Geneva no excluyen con seguridad a los pacientes con PE (17). Lo anterior indica la importancia y la necesidad de hacer estudios similares en población latinoamericana, para evaluar de manera confiable la aplicabilidad y reproducibilidad de estos criterios en el medio local.…”

Section: ¿Cómo Y En Quiénes Se Puede Excluirunclassified

Ronda clínica y epidemiológica: club de revistas

Mendoza-Mendoza

Restrepo-Álvarez

Caraballo

et al. 2018

iatreia

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RESUMENEn esta nueva edición de la Ronda Clínica y Epidemiológica, el lector podrá encontrar cuatro artículos que consideramos de especial interés para la práctica clínica actual. Abuzaid A. et al, realizan una revisión sistemática y meta-análisis que compara los desenlaces de la terapia con oxígeno vs. sin oxígeno en escenarios post-infarto agudo de miocardio. Freund Y., et al, presentan un ensayo clínico cluster de no inferioridad en el que buscan validar prospectivamente la seguridad de una estrategia basada en criterios clínicos para descartar embolismo pulmonar. Por otro lado, por medio de un diseño de cohorte retrospectiva con emparejamiento por índice de propensión, Pasternak, et al, se proponen investigar si el uso de fluoroquinolonas orales se asocia con un incremento en el riesgo de aneurisma o disección aórtica. Por último, el grupo de investigadores SMART evalúa, a través de un ensayo clínico pragmático en pacientes críticamente enfermos, el impacto de soluciones balanceadas en comparación al uso de solución salina normal en el riesgo de desarrollar eventos renales mayores.

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“…These results were combined with the search term "D-dimer," with the number of items reduced to 687. One derivation trial was acquired and appraised along with one validation trial (6,7). Finally, a Web of Science search was conducted for those articles referencing the original derivation article, which identified yet another validation trial (8).…”

Section: Evidence Searchmentioning

confidence: 99%