Use of clinical probability scores and D-dimer in suspected pulmonary embolism. Results from a Spanish retrospective study

Ramos‐Bossini, Antonio Jesús Láinez; Moreno-Suárez, S.; Pérez-García, María del Carmen; Gálvez-López, R.; Garrido-Sanz, Francisco; Rivera-Izquierdo, Mario

doi:10.1097/mej.0000000000000722

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…To reduce the number of CTPA procedures performed to rule out PE, different clinical decision rules (CDRs) have been derived and validated. Among them, the Wells and Geneva scores coupled with the D‐dimer assay have shown a high negative predictive value (NPV), allowing the exclusion of the diagnosis of PE without the need of chest imaging 5,6 . The D‐dimer assay is sensitive but not specific causing many false positives in low‐risk patients with subsequent negative CT scans.…”

Section: Introductionmentioning

confidence: 99%

“…Among them, the Wells and Geneva scores coupled with the D-dimer assay have shown a high negative predictive value (NPV), allowing the exclusion of the diagnosis of PE without the need of chest imaging. 5,6 The D-dimer assay is sensitive but not specific causing many false positives in low-risk patients with subsequent negative CT scans. This led to the development of a clinical rule, the PERC (Pulmonary Embolism Rule-out Criteria) rule, allowing PE to be ruled out on clinical criteria only.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the “hemoptysis” item in clinical decision rules for the diagnosis of pulmonary embolism in the emergency department

Bannelier

Gorlicki

Penaloza

et al. 2022

Academic Emergency Medicine

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Background: Hemoptysis is not common in pulmonary embolism (PE) and lacks specificity for its diagnosis. However, this item is present in different validated scores that estimate the clinical probability of PE. The relevance of this item in clinical decision rules (CDRs) is not clearly established. Objective:The aim of this study was to evaluate the impact of removing the "hemoptysis" item from the PERC, YEARS, and PEGeD CDR in patients with low clinical probability of PE.Design: This was a post hoc analysis of two European prospective cohorts, which included 2968 patients presenting to the ED with a low clinical probability of PE (PROPER and PERCEPIC) and a 3-month follow-up. The primary endpoint was the false-negative rate of a CDR score without the hemoptysis item. Secondary endpoints included the potential reduction of chest imaging if the item hemoptysis was to be removed and risk stratification of the Geneva and Wells scores without the hemoptysis item.Results: Of 2968 patients included (mean ± SD age 46 ± 18 years, 53% female), 87 patients (3%) had a PE diagnosed at 3 months. A total of 2908 were followed-up at 3 months and analyzed. Using the PERC rule with and without the hemoptysis item, there were 13 and 14 missed cases of PE, respectively (failure rate 0.45% [95% CI 0.25%-0.78%] and 0.48% [95% CI 0.27%-0.82%]). Using the YEARS strategy, there were 11 missed PE cases with or without the hemoptysis item (false-negative rate 0.57% [95% CI 0.30%-1.05%]). With the PERC and YEARS rule, removing the hemoptysis item would have led to a 1% reduction in chest imaging. The PEGeD strategy was not modified by the removal of the hemoptysis item. How to cite this article: Bannelier H, Gorlicki J, Penaloza A, et al. Evaluation of the "hemoptysis" item in clinical decision rules for the diagnosis of pulmonary embolism in the emergency department.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of the “hemoptysis” item in clinical decision rules for the diagnosis of pulmonary embolism in the emergency department

Bannelier

Gorlicki

Penaloza

et al. 2022

Academic Emergency Medicine

View full text Add to dashboard Cite

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“…The clinical presentation of acute PE encompasses a wide spectrum of signs and symptoms, and routine exams at the ED have low specificity for its detection [19]. Currently, the 'old standard' technique for the diagnosis of PE is computed tomography pulmonary angiography (CTPA), which has high sensitivity and specificity, allowing to detect even small (i.e., subsegmental) embolisms.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain

2022

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Several studies have been published showing a significant increase in thrombotic complications in coronavirus disease 2019 (COVID-19) patients, including acute pulmonary embolism (PE). However, there is significant variability regarding published data on the number of computed tomography pulmonary angiography (CTPA) orders to rule out PE, frequency and characteristics of PE, and other factors that could have magnified the actual incidence of PE. The aim of this work is to analyze these factors during the first year of the pandemic. A longitudinal retrospective observational study was designed comparing two cohorts (preCOVID and COVID) of patients for whom an emergency CTPA was requested to rule out PE at the emergency department of our institution. Information was collected regarding the number of CTPAs requested, patient demographics, presence and extension of PE, and radiological signs of right ventricle strain/pulmonary hypertension (RVS/PH). Univariate and bivariate analyses were performed, with stratification by time intervals according to different pandemic waves in the COVID cohort. A total of 1905 patients (530 in the pre-COVID cohort and 1375 in the COVID cohort), with a mean age of 68.3 years (standard deviation, 16.5) and 981 (51.5%) women were included. No significant differences were observed regarding the incidence of PE between both cohorts. In patients with PE, no significant differences regarding age or sex were found, but a significantly higher frequency of peripheral PE was observed in the COVID cohort (42.0% vs. 6.5%, p < 0.001). Regarding signs of RVS/PH, a lower degree of septal deviation and contrast reflux to the inferior vena cava was observed in the COVID cohort, but no significant differences were observed in the right-to-left ventricular ratio. For the COVID cohort, the distribution of central vs. peripheral PE was similar in patients without laboratory-confirmed COVID-19 infection. Finally, the analysis of signs of RVS/PH stratifying by pandemic waves showed a lower frequency of RVS/PH signs in the 2nd and 3rd pandemic waves. In conclusion, despite a significantly higher number of CTPAs were performed during the pandemic, the incidence of PE was similar to that of the pre-pandemic period. A higher number of peripheral PE and less radiological signs of RVS/PH were observed during the pandemic. These findings could be explained by an increased incidental detection of PE during the pandemic. Our study has some limitations, mainly derived from its retrospective and single-center nature, which should be overcome in future research.

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Use of clinical probability scores and D-dimer in suspected pulmonary embolism. Results from a Spanish retrospective study

Cited by 2 publications

References 11 publications

Evaluation of the “hemoptysis” item in clinical decision rules for the diagnosis of pulmonary embolism in the emergency department

Evaluation of the “hemoptysis” item in clinical decision rules for the diagnosis of pulmonary embolism in the emergency department

Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain

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