Pulmonary embolism in patients attending the accident and emergency department with pleuritic chest pain.

Thomas, Lori; Reichl, M.

doi:10.1136/emj.8.1.48

Cited by 4 publications

(1 citation statement)

References 8 publications

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“…34, 35, 120, 131 This value is difficult to estimate because of the range of complaints associated with PE and the frequency of those complaints in disorders unrelated to PE. Here we develop a conservative estimate of the prevalence of PE among patients presenting to the ED; then, below we describe how we estimated the PE prevalence in the modeled patient population.…”

Section: Calibration Of Data From Multiple Sourcesmentioning

confidence: 99%

Cost-Effectiveness of Strategies for Diagnosing Pulmonary Embolism Among Emergency Department Patients Presenting With Undifferentiated Symptoms

Duriseti

Brandeau

2010

Annals of Emergency Medicine

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Objective Symptoms associated with pulmonary embolism (PE) can be nonspecific and similar to many competing diagnoses, leading to excessive costly testing and treatment as well as missed diagnoses. Objective studies are essential for diagnosis. This study evaluates the cost-effectiveness of different diagnostic strategies in an Emergency Department (ED) for patients presenting with undifferentiated symptoms suggestive of PE. Methods Using a probabilistic decision model, we evaluated the incremental costs and effectiveness (quality-adjusted life years (QALYs) gained) of 60 testing strategies for five patient pretest categories (distinguished by Wells score (High, Moderate, or Low) and whether deep venous thrombosis (DVT) is clinically suspected). We performed deterministic and probabilistic sensitivity analyses. Results In the base case, for all patient pretest categories, the most cost-effective diagnostic strategy is to use an initial ELISA D-dimer test, followed by compression ultrasound (CUS) of the lower extremities if the D-dimer is above a specified cutoff. The level of the preferred cutoff varies with the Wells pretest category and whether a DVT is clinically suspected. D-dimer cutoffs higher than the current recommended cutoff were often preferred for even Moderate and High Wells category patients. CUS accuracy had to fall below commonly cited levels in the literature before it was not part of a preferred strategy. Conclusions When PE is suspected in the ED, use of an ELISA D-dimer assay, often at cutoffs higher than those currently in use (for patients in whom DVT is not clinically suspected), followed by CUS as appropriate, can reduce costs and improve outcomes.

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Section: Calibration Of Data From Multiple Sourcesmentioning

confidence: 99%

Cost-Effectiveness of Strategies for Diagnosing Pulmonary Embolism Among Emergency Department Patients Presenting With Undifferentiated Symptoms

Duriseti

Brandeau

2010

Annals of Emergency Medicine

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Prevalence and severity of pulmonary embolism are dependent on clinical and paraclinical parameters

Kocea

Mischke

Volk

et al. 2016

Med Klin Intensivmed Notfmed

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Diagnosis of Pulmonary Embolism

Meyer

Gal²,

Perrier

1998

N Engl J Med

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agents to be Streptococcus pneumoniae (15.3%), Haemophilus influenzae (10.9%), Legionella species (6.7%), and Chlamydia pneumoniae (6.1%). These findings strongly support including erythromycin in the empiric antibiotic treatment of community-acquired pneumonia. Two In all settings, when a specific etiologic agent is identified, antimicrobial therapy should be narrowed to avoid superinfection and the selection of drug-resistant bacteria. With regard to preventing nosocomial pneumonia in critically ill patients, a recent well-controlled study has shown that selective decontamination of the digestive tract does not improve survival in intubated patients receiving mechanical ventilation in intensive care units.

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Pulmonary embolism in patients attending the accident and emergency department with pleuritic chest pain.

Cited by 4 publications

References 8 publications

Cost-Effectiveness of Strategies for Diagnosing Pulmonary Embolism Among Emergency Department Patients Presenting With Undifferentiated Symptoms

Cost-Effectiveness of Strategies for Diagnosing Pulmonary Embolism Among Emergency Department Patients Presenting With Undifferentiated Symptoms

Prevalence and severity of pulmonary embolism are dependent on clinical and paraclinical parameters

Diagnosis of Pulmonary Embolism

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