Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians

Raja, Ali S.; Greenberg, Jack J.; Qaseem, Amir; Denberg, Thomas D.; Fitterman, Nick; Schuur, Jeremiah D.

doi:10.7326/m14-1772

Cited by 279 publications

(241 citation statements)

References 84 publications

Supporting

Mentioning

227

Contrasting

Unclassified

Order By: Relevance

“…Multiple guidelines, including the American College of Physicians/American Academy of Family Physicians, the American College of Emergency Physicians, and the European Society of Cardiology, recommend that PE can be ruled out if the clinical suspicion is low and the D‐dimer test is negative 17. However, in cases where the clinical suspicion is moderate or high and/or the D‐dimer test is positive, a conclusive imaging test such as a V/Q study or CTPA is needed to confirm or exclude the diagnosis of PE.…”

Section: Methodsmentioning

confidence: 99%

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

Toney

Kim

Palli

2017

Academic Emergency Medicine

View full text Add to dashboard Cite

ObjectiveThe objective was to quantify the potential economic value of single‐photon emission computed tomography (SPECT) with computed tomography (CT; SPECT/CT) versus CT pulmonary angiography (CTPA), ventilation–perfusion (V/Q) planar scintigraphy, and V/Q SPECT imaging modalities for diagnosing suspected pulmonary embolism (PE) patients in an emergency setting.MethodsAn Excel‐based simulation model was developed to compare SPECT/CT versus the alternate scanning technologies from a payer's perspective. Clinical endpoints (diagnosis, treatment, complications, and mortality) and their corresponding cost data (2016 USD) were obtained by performing a best evidence review of the published literature. Studies were pooled and parameters were weighted by sample size. Outcomes measured included differences in 1) excess costs, 2) total costs, and 3) lives lost per annum between SPECT/CT and the other imaging modalities. One‐way (±25%) sensitivity and three scenario analyses were performed to gauge the robustness of the results.ResultsFor every 1,000 suspected PE patients undergoing imaging, expected annual economic burden by modality was found to be 3.2 million (SPECT/CT), 3.8 million (CTPA), 5.8 million (planar), and 3.6 million (SPECT) USD, with a switch to SPECT/CT technology yielding per‐patient‐per‐month cost savings of $51.80 (vs. CTPA), $213.80 (vs. planar), and $36.30 (vs. SPECT), respectively. The model calculated that the incremental number of lives saved with SPECT/CT was six (vs. CTPA) and three (vs. planar). Utilizing SPECT/CT as the initial imaging modality for workup of acute PE was also expected to save $994,777 (vs. CTPA), $2,852,014 (vs. planar), and $435,038 (vs. SPECT) in “potentially avoidable”’ excess costs per annum for a payer or health plan.ConclusionCompared to the currently available scanning technologies for diagnosing suspected PE, SPECT/CT appears to confer superior economic value, primarily via improved sensitivity and specificity and low nondiagnostic rates. In turn, the improved diagnostic accuracy accords this modality the lowest ratio of expenses attributable to potentially avoidable complications, misdiagnosis, and underdiagnosis.

show abstract

Section: Methodsmentioning

confidence: 99%

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

Toney

Kim

Palli

2017

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Por otro lado, es importante resaltar que el bajo riesgo de los pacientes incluidos en el estudio fue determinado por el criterio clínico en la valoración inicial en el servicio de urgencias, lo cual va en contravía de las recomendaciones actuales de las guías internacionales (12,13), en las que se sugiere evaluar la probabilidad pretest a través de un modelo predictivo, el puntaje de Wells o Geneva, antes de solicitar el resto de los estudios necesarios para confirmar o descartar el diagnóstico. Aunque el criterio clínico puede tener igual validez que los puntajes mencionados, e incluso algunos estudios sugieren que presenta mejor rendimiento que los modelos predictivos (14,15), la poca reproducibilidad de una valoración subjetiva del riesgo sería un obstáculo para la aplicabilidad de los resultados.…”

Section: ¿Cómo Y En Quiénes Se Puede Excluirunclassified

Ronda clínica y epidemiológica: club de revistas

Mendoza-Mendoza

Restrepo-Álvarez

Caraballo

et al. 2018

iatreia

View full text Add to dashboard Cite

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.

show abstract

“…shows that a D-dimer assay has 85% to 98% sensitivity for PE diagnosis but has a low specificity [11]. Therefore, a D-dimer assay is indicated if there is low to moderate pretest likelihood of PE.…”

Section: Diagnosis and Diagnostic Testsmentioning

confidence: 99%

“…The study also urged the practitioner to order a D-dimer as the initial diagnostic test in patients who have an intermediate pretest probability and to avoid ordering a D-dimer assay if a high pretest probability of PE exists [11]. Studies show that a D-dimer level is an indirect measure of ongoing coagulation system activation, and it is a helpful test to avoid further diagnostic testing when there is a low (<2) or moderate (2 -6) pretest likelihood of PE [1] [11]. However, current research…”

Section: Diagnosis and Diagnostic Testsmentioning

confidence: 99%

“…In 2015, Raja et al [11] encouraged the practitioner not to obtain D-dimer measurements or imaging studies with a low pretest probability of PE. The study also urged the practitioner to order a D-dimer as the initial diagnostic test in patients who have an intermediate pretest probability and to avoid ordering a D-dimer assay if a high pretest probability of PE exists [11].…”

Section: Diagnosis and Diagnostic Testsmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Treatment Options for Pulmonary Embolism (PE) in the Acute Care Setting

Campa¹,

Gantioque²

2018

WJCD

View full text Add to dashboard Cite

Thromboembolic diseases continue to be one of the most prevalent medical problems today and can lead to life-threatening conditions, such as pulmonary embolism (PE). Currently, PE diagnosis and treatment are a challenge because of acute onset right ventricular strain with right-sided heart failure, sudden death, pulmonary infarction, and cardiogenic shock, which limit the time for therapeutic success. The aim of this study was to evaluate our perception, knowledge, and concerns regarding PE, discuss the importance of promptly diagnosing PE to provide appropriate treatment options for this life-threatening condition, list the most common clinical manifestations present when PE is suspected, and review the clinical approach to patients with suspected PE in an inpatient setting. In addition, this study reviews the risk stratification of patients with PE and treatment options beyond anticoagulation, compares new treatment options for patients presenting with acute symptomatic PE, and compares aspiration catheters (10 F Pronto .035" and 14 F XL extraction catheter (Vascular Solutions, Minneapolis, MN)) and ultrasound-assisted catheter-directed thrombolysis (USAT) versus systemic thrombolysis. This literature review was limited by the quality and number of studies available regarding new treatment options for patients presenting with acute symptomatic PE. Thus, more studies are needed to prove the validity of newer treatment options being trialed, such as aspiration catheters (10 F Pronto .035" and 14 F XL extraction catheter) and USAT, with the hope that further studies will guide patient management and increase our understanding of next generation aspiration catheters, which may provide novel insights on treating acute symptomatic PE.

show abstract

Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians

Cited by 279 publications

References 84 publications

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

The Economic Value of Hybrid Single‐photon Emission Computed Tomography With Computed Tomography Imaging in Pulmonary Embolism Diagnosis

Ronda clínica y epidemiológica: club de revistas

Diagnosis and Treatment Options for Pulmonary Embolism (PE) in the Acute Care Setting

Contact Info

Product

Resources

About