Screening for Postoperative Pulmonary Embolism on the Basis of Clinical Symptomatology, Routine Electrocardiography and Plain Chest Radiography

Abstract

The incidence of pulmonary embolism (PE) and the usefulness of various screening methods for its detection were studied in 108 patients undergoing elective hip surgery. Twenty patients had PE as shown by perfusion‐ventilation lung scintigraphy. Six of them had symptoms of embolism. Clinical symptoms of PE, highly suggestive electrocardiographic (ECG) signs and signs in chest radiographs showed high specificity but low sensitivity with regard to PE. If the non‐specific ECG signs and the symptoms and signs of deep vein thrombosis in the calves had also been taken into account, it would have been possible to identify 95% of the patients with PE. The use of all these screening tests revealed a suspicion of PE in two thirds of the patients. The simplest way to screen for postoperative PE seems to be to use a combination of the symptoms and signs of both PE and deep vein thrombosis, and to identify any tachycardia. This method gave a sensitivity of 85%.

Justification of using Computed Tomography and Magnetic Resonance Imaging for Deep Venous Thrombosis and Pulmonary Embolism

“…In combination with a 'high clinical pretest probability' or 'echocardiographic signs' of 'right ventricular dysfunction', accuracy of ECG to diagnose PE (Pulmonary embolism) may be improved. [19] Physicians should be aware about that, ECG-report may be 'entirely normal' in up to 20% of patients with PE resulting in a low sensitivity for the exclusion of the diagnosis.…”