Challenges and Changes to the Management of Pulmonary Embolism in the Emergency Department

Moore, Chris; McNamara, Katelyn; Liu, Rachel

doi:10.1016/j.ccm.2018.04.009

Cited by 4 publications

(3 citation statements)

References 60 publications

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“…• Пациенту, находящемуся в травматологическом или ортопедическом отделении при подозрении на легочную тромбоэмболию в экстренном порядке необходимо выполнить электрокардиографию и рентгенографию органов грудной клетки для исключения иной патологии сердечно-сосудистой и дыхательной систем [28,101,102,103] УУР А (УДД -2).…”

Section: инструментальная диагностикаunclassified

Prevention, Diagnosis and Treatment of Thromboembolic Complications in Traumatology and Orthopedics: Methodological Guidelines

Божкова¹,

Tikhilov²,

Andriyashkin

et al. 2022

Traumatology and Orthopedics of Russia

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The guidelines describe modern approaches to the prevention, diagnosis, and treatment of thromboembolic complications in patients with injuries and after musculoskeletal surgery, in accordance with the interdisciplinary draft of the Clinical Guidelines (2022) Deep vein thrombosis of the extremities, which has passed public hearings and is being approved by the Russian Ministry of Health. The guidelines are designed for doctors of various specialties to provide medical care to specialized patients: orthopedic surgeons, anesthesiologists, resuscitators, clinical pharmacologists, health care organizers, medical students, residents, graduate students.

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Section: инструментальная диагностикаunclassified

Prevention, Diagnosis and Treatment of Thromboembolic Complications in Traumatology and Orthopedics: Methodological Guidelines

Божкова¹,

Tikhilov²,

Andriyashkin

et al. 2022

Traumatology and Orthopedics of Russia

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“…Some authors therefore suggested that pulmonary embolism should be suspected in all patients presenting to the emergency department with progressive dyspnea, chest pain, or sustained hypotension and no obvious alternate cause [ 7 – 9 ]. Because of the overlap of the main symptoms of HF and pulmonary embolism [ 8 , 10 ], the distinction of these two entities may be hampered in the emergency setting.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

et al. 2022

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Objectives To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients. Methods In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 ± 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HUratio) and difference (HUdiff) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis. Results Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980–0.991). NT-pro BNP exhibited moderate correlations with HUratio (r = 0.50, p < 0.001) and HUdiff (r = 0.50, p < 0.001). In the training cohort, HUratio (AUC: 0.89, 95%CI: 0.82–0.95) and HUdiff (AUC: 0.88, 95%CI: 0.81–0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HUratio (sensitivity 93%; specificity 75%) and 113 for HUdiff (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HUratio and HUdiff, respectively. Conclusion In emergency department patients undergoing CTPA and showing no PE, both HUratio and HUdiff have a high sensitivity for diagnosing acute HF. Key Points • Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography. • In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.

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“…It is still a challenge to reduce mortality and improve prognosis through rapid and accurate diagnosis and management. [ 1 2 ] The status of RV in response to the PE-induced acute pressure overload can be reflected by electrocardiography (ECG). Data from these published studies summarized that tachycardia, McGinn-White sign (S 1 Q 3 T 3 ), right bundle branch block (RBBB), and T-wave inversion of leads V 1 –V 3 (TWI) are the most predominant signs of RV strain.…”

Section: Introductionmentioning

confidence: 99%

Contribution of Quick Sequential Organ Failure Assessment Score Combined with Electrocardiography in Risk Stratification of Patients with Acute Pulmonary Embolism

Teng

Chen

et al. 2018

Chinese Medical Journal

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Background:The quick Sequential Organ Failure Assessment (qSOFA) score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism (PE) by combining with electrocardiography (ECG).Methods:Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low - risk groups by imaging and biomarkers. The ECG scores consisted of tachycardia, McGinn-White sign (S1Q3T3), right bundle branch block, and T-wave inversion of leads V1–V3. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve.Results:Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score + ECG score was created. The optimal cutoff value for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index (PESI) and simplified PESI.Conclusions:The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.

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Challenges and Changes to the Management of Pulmonary Embolism in the Emergency Department

Cited by 4 publications

References 60 publications

Prevention, Diagnosis and Treatment of Thromboembolic Complications in Traumatology and Orthopedics: Methodological Guidelines

Prevention, Diagnosis and Treatment of Thromboembolic Complications in Traumatology and Orthopedics: Methodological Guidelines

Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy

Contribution of Quick Sequential Organ Failure Assessment Score Combined with Electrocardiography in Risk Stratification of Patients with Acute Pulmonary Embolism

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