Delay and misdiagnosis in sub-massive and non-massive acute pulmonary embolism

Alonso-Martínez, José Luis; Sánchez, F.J. Anniccherico; Echezarreta, M. A. Urbieta

doi:10.1016/j.ejim.2010.04.005

Cited by 59 publications

(56 citation statements)

References 20 publications

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“…El aumento de presión en el ventrículo derecho conduce a dilatación, disfunción e isquemia del mismo, y el fallo cardíaco derecho predispone a inestabilidad hemodinámica y shock cardiogénico 18 . Los casos con mayor repercusión hemodinámica se diagnostican antes 25 , pero tienen un peor pronóstico a corto plazo, siendo la presencia de hipotensión el mejor predictor de evolución desfavorable 26 . La presencia de taquicardia, ingurgitación yugular, refuerzo del cierre de la pulmonar y hepatomegalia sugieren disfunción ventricular, y son datos que podrían ayudar a identificar a aquellos pacientes con TEP submasivo 27 .…”

Section: Tromboembolismo Pulmonarunclassified

“…Los pacientes pueden retrasar la solicitud de evaluación médica debido a que el TEP cursa con clínica similar a la que presentan durante la agudización de comorbilidades 32 como la enfermedad cardíaca, en especial en aquellos con disnea de instauración progresiva 25 .…”

Section: Tromboembolismo Pulmonarunclassified

“…Un nivel educativo elevado también se asocia con mayor retraso en la consulta 32,33 . En cambio, son motivos de consulta precoz la importancia otorgada a un sín-toma concreto, como el síncope, la disnea súbita 25 , la hipotensión o la frecuencia respiratoria elevada 33 ; así como la percepción de gravedad por parte del paciente 34 . Los casos con antecedente de TEP probablemente consultan antes porque recuerdan los síntomas del episodio anterior 25 .…”

Section: Tromboembolismo Pulmonarunclassified

“…En cambio, son motivos de consulta precoz la importancia otorgada a un sín-toma concreto, como el síncope, la disnea súbita 25 , la hipotensión o la frecuencia respiratoria elevada 33 ; así como la percepción de gravedad por parte del paciente 34 . Los casos con antecedente de TEP probablemente consultan antes porque recuerdan los síntomas del episodio anterior 25 . Otro punto de especial interés es el retraso en la confirmación diagnóstica, que puede ser debido a diversos motivos:…”

Section: Tromboembolismo Pulmonarunclassified

“…La inespecificidad de los síntomas del TEP, bajas puntuaciones en escala de Wells o ausencia de síncope o disnea súbita dan lugar a diagnósti-cos erróneos 25 .…”

Section: Tromboembolismo Pulmonarunclassified

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Trombo-embolismo pulmonar: necesitamos sospecha clínica

García-Sanz¹,

Pena-Álvarez

González‐Barcala

2012

Anales Sis San Navarra

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RESuMENLa enfermedad tromboembólica venosa (ETV) es un importante problema de salud, con una incidencia anual de 1-2 casos /1.000 personas. Un tercio de los pacientes con ETV sintomática cursan con tromboembolismo pulmonar (TEP), que es frecuentemente infradiagnosticado debido a su presentación clínica variable e inespecífica. El conocimiento de los signos y síntomas de la ETV puede reducir los retrasos en el diagnóstico y, con ello, la morbimortalidad asociada. Sin embargo, el TEP se puede presentar con un amplio espectro clínico, desde apenas síntomas hasta shock o inestabilidad hemodinámica, por lo que no debemos limitar la sospecha de TEP a aquellos pacientes con presentación típica; además esta posibilidad diagnóstica debe ser considerada no sólo ante la presencia de síntomas agudos, sino también en aquellos pacientes con síntomas respiratorios de evolución prolongada.Palabras clave. Tromboembolismo pulmonar. Diagnós-tico diferencial. Síndromes clínicos. Síntomas frecuentes. Retraso diagnóstico. ABSTRACTVenous thromboembolism (VTE) is a major health problem, with an annual incidence of 1-2 per 1,000 person-years. One in three patients with symptomatic VTE presents pulmonary embolism (PE), which is often underdiagnosed due to variable and nonspecific clinical presentation. Knowing the signs and symptoms of VTE can reduce delays in diagnosis, and thus VTErelated morbidity and mortality as well. Nevertheless, PE can present a wide clinical spectrum, ranging from being asymptomatic to shock or hemodynamic instability, which is why PE suspicion should not be limited to those patients with typical presentation. Therefore, this diagnostic possibility should not only be considered for patients with acute symptoms, but also for those with persistent respiratory symptoms.

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Section: Tromboembolismo Pulmonarunclassified

“…La inespecificidad de los síntomas del TEP, bajas puntuaciones en escala de Wells o ausencia de síncope o disnea súbita dan lugar a diagnósti-cos erróneos 25 .…”

Section: Tromboembolismo Pulmonarunclassified

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Trombo-embolismo pulmonar: necesitamos sospecha clínica

García-Sanz¹,

Pena-Álvarez

González‐Barcala

2012

Anales Sis San Navarra

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Impact of an enhanced focused cardiac ultrasound on treatment changes in a population of internal medicine patients

Flamanc,

de Carvalho,

Le Bastard

et al. 2023

J of Clinical Ultrasound

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BackgroundHospitalized patients with acute shortness of breath (SOB) could benefit from an enhanced focused cardiac ultrasound (eFoCUS) with Doppler measurements to reassess treatment and diagnosis.MethodsThis was a retrospective observational study performed in a medical ward. Included patients were those hospitalized for acute SOB. The objectives were to assess therapeutic and diagnosis changes associated with eFoCUS. The primary endpoint of the analysis was a composite of introduction or discontinuation of diuretics, antibiotics or anticoagulation following eFoCUS.ResultsBetween January 2018 and July 2021, 119 patients were included, 67 women and 52 men, mean age 84 ± 11 years old. The eFoCUS was performed within a median time of 55 h (1st–3rd IQ: 21–107) following hospital admission. Overall, eFoCUS was associated with a change in diagnostic in 40 patients (34% [CI 95%: 25%–43%], p < 10−4) and a change in treatment in 53 patients (45% [CI 95%: 35%–54%], p < 10−4). Diuretics were prescribed in 94 patients before eFoCUS and in 56 after (p = 10−4), antibiotics in 34 before and 27 after and anticoagulation in 30 before and 40 after.ConclusioneFoCUS was associated with both therapeutic and diagnostic changes in patients with SOB. Such results should be confirmed in multicentric prospective studies.

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Automatic detection of pulmonary embolism in computed tomography pulmonary angiography using Scaled‐YOLOv4

et al. 2023

Medical Physics

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Background Pulmonary embolism (PE) is a common but fatal clinical condition and the gold standard of diagnosis is computed tomography pulmonary angiography (CTPA). Prompt diagnosis and rapid treatment can dramatically reduce mortality in patients. However, the diagnosis of PE is often delayed and missed. Methods In this study, we identified a deep learning model Scaled‐YOLOv4 that enables end‐to‐end automated detection of PE to help solve these problems. A total of 307 CTPA data (Tianjin 142 cases, Linyi 133 cases, and FUMPE 32 cases) were included in this study. The Tianjin dataset was divided 10 times in the ratio of training set: validation set: test set = 7:2:1 for model tuning, and both the Linyi and FUMPE datasets were used as independent external test sets to evaluate the generalization of the model. Results Scaled‐YOLOv4 was able to process one patient in average 3.55 s [95% CI: 3.51–3.59 s]. It also achieved an average precision (AP) of 83.04 [95% CI: 79.36–86.72] for PE detection on the Tianjin test set, and 75.86 [95% CI: 75.48–76.24] and 72.74 [95% CI: 72.10–73.38] on Linyi and FUMPE, respectively. Conclusions This deep learning algorithm helps detect PE in real time, providing radiologists with aided diagnostic evidence without increasing their workload, and can effectively reduce the probability of delayed patient diagnosis.

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Delay and misdiagnosis in sub-massive and non-massive acute pulmonary embolism

Cited by 59 publications

References 20 publications

Trombo-embolismo pulmonar: necesitamos sospecha clínica

Trombo-embolismo pulmonar: necesitamos sospecha clínica

Impact of an enhanced focused cardiac ultrasound on treatment changes in a population of internal medicine patients

Automatic detection of pulmonary embolism in computed tomography pulmonary angiography using Scaled‐YOLOv4

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