Can We Rely on Computed Tomographic Scanning to Diagnose Pulmonary Embolism in Critically Ill Surgical Patients?

Velmahos, George C.; Toutouzas, Konstantinos G.; Vassiliu, Pantelis; Rhee, Peter; Wilcox, Alison; Hanks, Sue E.; Chan, Linda S.; Tillou, Areti; Δημητριάδης, Δημήτριος

doi:10.1097/01.ta.0000114535.64175.c5

Cited by 18 publications

(9 citation statements)

References 31 publications

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“…Following this selection process, 14 studies comparing spiral CT to PA [3,14,18–29] and four prospective pragmatic studies [6,30–32] remained for analysis; one additional prospective pragmatic study, initially published as an abstract, but subsequently in full was also included [7]. Agreement between both authors exceeded 95% of all extracted data; discrepancies were resolved by consensus.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and management of subsegmental pulmonary embolism

Gal

Righini

Parent

et al. 2006

Journal of Thrombosis and Haemostasis

146

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Summary. Introduction: Although the advent of multi‐detector row computed tomography (CT) has enabled better visualization of subsegmental pulmonary (SSP) arteries, SSP embolism is of uncertain clinical significance. We aimed at answering the following questions: Is spiral CT an accurate method to detect SSP embolism? How are subsegmental perfusion defects managed in outcome studies including spiral CT? What are the main characteristics and outcomes of patients in whom CT detects isolated subsegmental defects? Methods: We performed a Medline search on July 1, 2004, using the keywords ‘pulmonary embolism’ and ‘computed tomography’. We limited our search to English language prospective studies comparing CT to pulmonary angiography, and to prospective outcome studies including CT in a diagnostic strategy, with at least a 3‐month follow‐up. Results: Fourteen studies comparing CT to pulmonary angiography, and five prospective management studies using CT were retrieved. The sensitivity of single‐detector CT for detecting subsegmental defects compared with pulmonary angiography was low (25%). The proportion of isolated SSP images was significantly higher in management studies using multi‐detector CT (17 of 770 scans, 2.2%) compared with those using single‐detector CT (22 of 2232, 1.0%; P = 0.01). No straightforward attitude regarding anticoagulation therapy for isolated subsegmental defects emerged from the available literature. Finally, important clinical differences were found between patients having subsegmental and segmental or more proximal defects. Conclusions: These findings underline the uncertainty regarding the clinical significance of SSP embolism, and the management of patients with such findings.

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Section: Resultsmentioning

confidence: 99%

Diagnosis and management of subsegmental pulmonary embolism

Gal

Righini

Parent

et al. 2006

Journal of Thrombosis and Haemostasis

146

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“…29 -31 Because of the potential hemorrhagic complications, many surgeons think that the use of anticoagulation in trauma patients is relatively contraindicated. 27,31 The ineffectiveness and complications of anticoagulant and mechanical prophylaxis have led to the "extended" or prophylactic use of VCFs. 6,10 Prophylactic VCFs have been associated with a reduction in symptomatic and fatal pulmonary emboli when compared with historic controls.…”

Section: Discussionmentioning

confidence: 99%

“…DVT occurs in up to 58% of severely injured patients, and PE causes up to 5% of deaths in trauma patients hospitalized for more than 48 hours. 1,3,26,27 Clinical and epidemiologic factors associated with increased risk of VTE after trauma include the following: age Ն40 years, Injury Severity Score Ͼ9, 23 lower extremity fracture, pelvic fracture, severe head injury, venous injury, vertebral fracture, or spinal cord injury. 2,7,9,10,28 The presence of more than one risk factor is associated with a significantly higher incidence of VTE.…”

Section: Discussionmentioning

confidence: 99%

The Increasing Use of Vena Cava Filters in Adult Trauma Victims: Data From the American College of Surgeons National Trauma Data Bank

Shackford

Cook

Rogers

et al. 2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…CT is another complementary modality that can help with non diagnostic studies in minimizing the number of patients undergoing pulmonary angiography. It is useful in detecting central emboli but data are controversial for peripheral emboli [33,34,35,37] Several studies have shown that this modality can not be reliable to withhold the anticoagulant therapy based on a negative spiral CT and it needs to be explored further before being accepted as a replacement for V/Q scans [38]. It was found that it has no added value in patients with high probability V/Q scans and has a comparable diagnostic value with SPECT V/Q scans [36].…”

Section: Spiralmentioning

confidence: 99%

DIAGNOSIS OF PULMONARY EMBOLISM: A CONTINUING DILEMMA. ELGAZZAR, A.H. MD, FCAP and AL ENIZI, E. MD, KBNM Department of Nuclear Medicine, Kuwait University.

2009

The Egyptian Journal Nuclear Medicine

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Basic considerations: 1 The vast majority of pulmonary emboli are thromboemboli originating from deep veins. Fat, air, or tumor emboli are rare [1]. Fat emboli are reported with long bone fractures and liposuction while air emboli occur with cardiac and neurosurgeries. Renal cell carcinoma with invasion reaching inferior vena cava is a clinical setting that may lead to tumor emboli. Data indicate that 90% of pulmonary thromboemboli originate from the lower extremities and pelvis. The remainder come from thrombi that occur in the right side of the heart or in bronchial or cervical veins. Embolization and symptomatology are proportional to how proximal is the vein that contains the thrombus. The vast majority of pulmonary thromboemboli originating from thrombi of the lower extremities come more frequently from the thigh and pelvis (75%) than from smaller veins of the calf and feet [2,3]. The risk of pulmonary embolus is also directly related to the presence of a residual clot at the site of a venous thrombus [4]. One of three events can happen during the natural history of venous thrombi. First, the red thrombus grows explosively and obstructs the vein

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Can We Rely on Computed Tomographic Scanning to Diagnose Pulmonary Embolism in Critically Ill Surgical Patients?

Abstract: PA remains the "gold standard" for diagnosis of PE in critically ill surgical patients. CTPA should be explored further before being universally accepted. Clinical criteria are unreliable for detecting PE in this population and therefore a high index of suspicion should be maintained.

Cited by 18 publications

References 31 publications

Diagnosis and management of subsegmental pulmonary embolism

Diagnosis and management of subsegmental pulmonary embolism

The Increasing Use of Vena Cava Filters in Adult Trauma Victims: Data From the American College of Surgeons National Trauma Data Bank

DIAGNOSIS OF PULMONARY EMBOLISM: A CONTINUING DILEMMA. ELGAZZAR, A.H. MD, FCAP and AL ENIZI, E. MD, KBNM Department of Nuclear Medicine, Kuwait University.

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