Guidelines on the diagnosis and management of acute pulmonary embolism

Torbicki, Adam; Perrier, Arnaud; Konstantinides, Stavros; Agnelli, Giancarlo; Galiè, Nazzareno; Pruszczyk, Piotr; Bengel, Frank M.; Brady, Adrian; Ferreira, Daniel; Janssens, Uwe; Klepetko, Walter; Mayer, Eckhard; Rémy‐Jardin, Martine; Bassand, Jean‐Pierre; Vahanian, Alec; Camm, John; Caterina, Raffaele De; Dean, Veronica; Dickstein, Kenneth; Filippatos, Gerasimos; Funck‐Brentano, Christian; Hellemans, Irene; Kristensen, Steen Dalby; McGregor, Keith; Sechtem, Udo; Silber, Sigmund; Tendera, Michał; Widimský, Petr; Zamorano, José Luís; Zamorano, José-Luis; Andreotti, Felicita; Ascherman, Michael; Athanassopoulos, George; Sutter, Johan De; Fitzmaurice, David; Forster, Tamás; Heras, Magda; Jondeau, Guillaume; Kjeldsen, Keld; Knuuti, Juhani; Lang, Irene M.; Lenzen, Mattie J.; López‐Sendón, José; Nihoyannopoulos, Petros; Isla, Leopoldo Pérez de; Schwehr, Udo; Torraca, Lucia; Vachiéry, Jean‐Luc

doi:10.1093/eurheartj/ehn310

Cited by 1,747 publications

(491 citation statements)

References 368 publications

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“…Despite the high diagnostic accuracy of CTPA, less than 10% of the scans done to diagnose PE in the USA are positive, compared to a rate of 30% in European countries [3,7–10]. Moreover, CTPA comes with a high risk from exposure to ionizing radiation as well as risk from contrast-induced nephropathy [11,12]. …”

Section: Discussionmentioning

confidence: 99%

Computed tomography pulmonary angiography is overused to diagnose pulmonary embolism in the emergency department of academic community hospital

Osman

Subedi

Ahmed

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Background: Pulmonary embolism (PE) is a common disease in the USA responsible for up to 10% of hospital mortality. Modified wells score (MWS) and D-dimer assay are used to categorize patients into high or low probability of PE. Patient with high probability need Computed tomography pulmonary angiography (CTPA), while patients with low probability and low D-dimer can safely forgo the CTPA. Objectives: The aim of this study was to investigate the rate of inappropriate CTPA use in the emergency department of a community teaching hospital. Methods: A retrospective chart review of adult patients who underwent CTPA for suspected PE in the emergency department for 2015 was done. CTPA use was considered inappropriate if MWS was less than or equal to 4 and D-dimer was either not ordered or its value was less than 500 μg/L. Bivariate analysis with Fisher’s exact tests and Student’s t-tests as well as multivariate logistic regression analysis were done to examine relationship between study explanatory variables and study outcome. Results: 295 patients were included in the study. The mean age was 51.2(±14.5) years, 68.8% were females. The prevalence of PE was 5.4% and 41% of the CTPAs -were inappropriately ordered. Males were twice (OR 2.1; 95% CI 1.2, 3.6) as likely as females to have an inappropriately ordered CTPA after controlling for a high MWS, age, and tobacco history. Conclusion: CTPA is overused to diagnose PE in the emergency department. Quality improvement projects are needed to encourage physicians to adhere to the current guidelines.

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Section: Discussionmentioning

confidence: 99%

Computed tomography pulmonary angiography is overused to diagnose pulmonary embolism in the emergency department of academic community hospital

Osman

Subedi

Ahmed

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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“…Patients with RV failure have a poorer prognosis compared to individuals with normal RV function. Accordingly, identifying RV malfunctions following PE is beneficial for risk stratification and also, the better selection of therapeutic approach (23).…”

Section: Discussionmentioning

confidence: 99%

Correlation of the Wells and Simplified Revised Geneva Scores with CT Pulmonary Artery Obstruction Index in Pulmonary Embolism

2017

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Background: The pulmonary artery obstruction index (PAOI), which is evaluated by the CT pulmonary angiography, offers an objective method to measure the severity of pulmonary arteries obstruction. Objectives: We decided to investigate the correlation between the PAOI determined by CT pulmonary angiography, as an index to determine the severity of pulmonary embolism (PE), with two clinical models used for predicting the probability of acute PE, namely the Wells criteria and the simplified revised Geneva score. Patients and Methods: Sixty-four consecutive patients with definite diagnosis of acute PE based on CT pulmonary angiography were enrolled. The Wells score as well as simplified revised Geneva score were calculated retrospectively using the medical records. Then, the PAOI was determined by CT pulmonary angiography. By applying the Pearson's correlation coefficient, the relationships were investigated. Results: The Wells score had a weak correlation with the PAOI (r = 0.29; P = 0.01). The simplified revised Geneva score did not have significant correlation with the PAOI (r = 0.1; P = 0.2). Furthermore, patients with active cancer had significantly higher CT indexes than the other patients with PE (P = 0.046). Conclusion: Although the Wells and simplified revised Geneva scores are used widely for assessing clinical probability of PE, these scores may not necessarily correlate with the severity of PE. The Wells score had a weak correlation and may somehow predict the severity of PE. Malignancy is a significant risk factor found to be correlated with more severe PE.

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“…In case of massive critical PE (the lesion area of the pulmonary vascular bed is more than 70%) with the development of severe cardiopulmonary insufficiency and high risk of death one considers possibilities of thrombolytic therapy, selective intra-arterial thrombolysis with destruction and aspiration of thromboemboli as well as open embolectomy. The publications analyzing these variants of treatment provide mainly a series of descriptions of clinical observations [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Experience in Diagnostics and Surgical Treatment of Pulmonary Embolism in Pregnant Women

Medvedev¹,

Максимов²,

Немирова³

et al. 2017

Sovrem Tehnol Med

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Guidelines on the diagnosis and management of acute pulmonary embolism

Cited by 1,747 publications

References 368 publications

Computed tomography pulmonary angiography is overused to diagnose pulmonary embolism in the emergency department of academic community hospital

Computed tomography pulmonary angiography is overused to diagnose pulmonary embolism in the emergency department of academic community hospital

Correlation of the Wells and Simplified Revised Geneva Scores with CT Pulmonary Artery Obstruction Index in Pulmonary Embolism

Experience in Diagnostics and Surgical Treatment of Pulmonary Embolism in Pregnant Women

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