Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age

Gal, Grégoire Le; Righini, Marc; Roy, Pierre Marie; Meyer, Guy; Aujesky, Drahomir; Perrier, Arnaud; Bounameaux, Henri

doi:10.1111/j.1538-7836.2005.01598.x

Cited by 61 publications

(19 citation statements)

References 26 publications

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“…Three studies reported abnormalities in less of one half of patients at chest X-ray (Busby et al 1988; Ramos et al 2000; Le Gal et al 2005) while in other three studies more than 70% of patients had abnormalities (Stein et al 1991; Masotti et al 2000; Ceccarelli et al 2003). Cardiomegaly (range 22%–64%), pleural effusion (15.8%–57%), and (8.5%–71%) were the most frequent reported aspects.…”

Section: Resultsmentioning

confidence: 94%

“…These data derived from twelve selected articles (Busby et al 1988; Stein et al 1991; Jones et al 1993; Gisselbrcht et al 1996; Masotti et al 2000; Ramos et al 2000; Ceccarelli et al 2003; Timmons et al 2003; Kokturk et al 2005; Le Gal et al 2005; Punukollu et al 2005; Chung et al 2006). From ten of them, we derived data for acute mortality, symptoms, signs and risk factors for VTE (Busby et al 1988; Stein et al 1991; Gisselbrcht et al 1996; Masotti et al 2000; Ramos et al 2000; Ceccarelli et al 2003; Timmons et al 2003; Kokturk et al 2005; Le Gal et al 2005; Punukollu et al 2005); from seven articles we derived data for 12-leads ECG (Stein et al 1991; Masotti et al 2000; Ramos et al 2000; Ceccarelli et al 2003; Timmons et al 2003; Kokturk et al 2005), from six data for chest X-ray (Busby et al 1988; Stein et al 1991; Masotti et al 2000; Ramos et al 2000; Ceccarelli et al 2003; Le Gal et al 2005), from four data for TTE and from seven data for ABG (Stein et al 1991; Jones et al 1993; Gisselbrcht et al 1996; Masotti et al 2000; Ramos et al 2000; Ceccarelli et al 2003; Kokturk et al 2005).…”

Section: Resultsmentioning

confidence: 99%

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Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

Masotti¹

2008

VHRM

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Objective: Diagnosis of pulmonary embolism (PE) remains diffi cult and is often missed in the elderly due to nonspecifi c and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more. Materials and Methods: Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE) in the title, abstract or text, were reviewed. Results: Dyspnea (range 59%-91.5%), tachypnea (46%-74%), tachycardia (29%-76%), and chest pain (26%-57%) represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%-67%); deep vein thrombosis was detected in 15%-50% of cases. Sinus tachycardia, right bundle branch block, and ST-T abnormalities were the most frequent ECG fi ndings. Abnormalities of chest X-ray varied (less than 50% in one-half of the studies and more than 70% in the other one-half). Arterial blood gas analysis revealed severe hypoxemia and mild hypocapnia as the main fi ndings. D-Dimer was higher than cut-off in 100% of patients in 75% of studies. Clinical usefulness of D-Dimer measurement decreases with age, although the strategies based on D-Dimer seem to be cost-effective at least until 80 years. Conclusion: Despite limitations due to pooling data of heterogeneous studies, our review could contribute to the knowledge of the presentation of PE in the elderly with its diagnostic diffi culties. A diagnostic strategy based on reviewed data is proposed.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

Masotti¹

2008

VHRM

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“…Unlike younger patients, elderly patients often do not have typical symptoms and imaging findings of VTE, suggesting that perioperative management needs to be modified according to age [17], [18].The majority of preventable deaths for VTE are ascribed to missed or late diagnosis rather than to failure of therapy [19].…”

Section: Discussionmentioning

confidence: 99%

Predicting Perioperative Venous Thromboembolism in Japanese Gynecological Patients

et al. 2014

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ObjectiveTo develop a convenient screening method that can predict perioperative venous thromboembolism (VTE) and identify patients at risk of fatal perioperative pulmonary embolism (PE).MethodsPatients hospitalized for gynecological abdominal surgery (n = 183) underwent hematology tests and multidetector computed tomography (MDCT) to detect VTE. All statistical analyses were carried out using the SPSS software program (PASWV19.0J)ResultsThe following risk factors for VTE were identified by univariate analysis: plasmin-alpha2-plasmin inhibitor complex (PIC), thrombin-antithrombin III complex (TAT), and prolonged immobility (all p<0.001); age, neoadjuvant chemotherapy (NAC), malignancy, hypertension, past history of VTE, and hormone therapy (all p<0.01); and hemoglobin, transverse tumor diameter, ovarian disease, and menopause (all p<0.05). Multivariate analysis using these factors revealed that PIC, age, and transverse tumor diameter were significant independent determinants of the risk of VTE. We then calculated the incidence rate of perioperative VTE using PIC and transverse tumor diameter in patient groups stratified by age. In patients aged≦40 years, PIC ≧1.3 µg/mL and a transverse tumor diameter ≧10 cm identified the high-risk group for VTE with an accuracy of 93.6%. For patients in their 50 s, PIC ≧1.3 µg/mL identified a high risk of VTE with an accuracy of 78.2%. In patients aged ≧60 years, a transverse tumor diameter ≧15 cm (irrespective of PIC) or PIC ≧1.3 µg/mL identified the high-risk group with an accuracy of 82.4%.ConclusionsWe propose new screening criteria for VTE risk that are based on PIC, transverse tumor diameter, and age. Our findings suggest the usefulness of these criteria for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE.

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“…Specifically, among nine symptoms and clinical signs of PE or deep vein thrombosis reported for ED patients, two (chest pain and syncope) showed no significant positive likelihood for a diagnosis of PE. 29 …”

Section: Discussionmentioning

confidence: 99%

U.S. Trends in Computed Tomography Use and Diagnoses in Emergency Department Visits by Patients With Symptoms Suggestive of Pulmonary Embolism, 2001–2009

Feng

Pines

Yusuf

et al. 2013

Academic Emergency Medicine

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Objectives Using computed tomography (CT) to evaluate patients with chest symptoms is common in emergency departments (EDs). This article describes recent trends of CT use in U.S. EDs for patients presenting with symptoms common to acute pulmonary embolism (PE). Methods The 2001–2009 National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative survey of U.S. ED encounters, was used for data collection. Patients with at least one of three complaints (chest pain, dyspnea, or hemoptysis) were categorized into the chest symptom study (CSS) group. The yearly increases in CT use for the complaints were tabulated first, then linear regression analysis was used to calculate average rates of increases in CT use between 2001 and 2007, the years where CT use increased, for the overall population and among specific subgroups. The ratios of the number of visits when CT was ordered and there was a target diagnosis relative to the total number of visits with CT in the CSS group (diagnosis/CT ratio) were calculated for PE and pneumonia. Results Annual CT rates for the CSS group increased from 2.6% in 2001 to 13.2% in 2007, subsequently leveling off at approximately 12.5% in 2008 and 2009. The average growth rate of CT use for the CSS group was 28.1% (95% confidence interval [CI] = 20.9% to 35.7%) per year between 2001 and 2007. Testing rates for all subgroups increased. The lowest growth rate was among Hispanic patients, whose CT rates grew 14.2% (95% CI = 5.7% to 23.5%) per year. The highest growth rate was in nonurban hospitals, at 43.1% (95% CI = 15.2% to 77.8%) per year. Patients triaged as nonurgent received the fewest CTs, compared to those who should be seen in 2 hours or less. With regard to sources of payment, the self-pay subgroup experienced the highest rate of increase at 35.1% (95% CI = 18.6% to 53.9%). The PE diagnosis/CT ratio from 2002 to 2009 was 2.7% for the CSS group. The pneumonia diagnosis/CT ratio grew from 5.8% in 2002 to 2005 to 7.8% in 2006 to 2009. Conclusions Computed tomography use in ED visits by patients with chest symptoms increased dramatically from 2001 to 2007 and seems to have leveled off in subsequent years. The low PE diagnosis-to-CT ratio suggests that EDs may need to promote evidence-based use of CT.

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Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age

Cited by 61 publications

References 26 publications

Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

Predicting Perioperative Venous Thromboembolism in Japanese Gynecological Patients

U.S. Trends in Computed Tomography Use and Diagnoses in Emergency Department Visits by Patients With Symptoms Suggestive of Pulmonary Embolism, 2001–2009

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