Systematic Review and Meta‐analysis of Pregnant Patients Investigated for Suspected Pulmonary Embolism in the Emergency Department

Kline, Jeffrey A.; Richardson, Danielle; Than, Martin; Penaloza, Andréa; Roy, Pierre‐Marie

doi:10.1111/acem.12471

Cited by 61 publications

(54 citation statements)

References 56 publications

(103 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The analysis reported by Kline et al 25 and 10 of the studies identified by our review reported the overall prevalence of PE, which was generally found to be low when compared with the non-pregnant population, but did not examine the diagnostic accuracy of clinical features, CDRs or the D-dimer measurement. The remaining seven studies were mostly small and had a low prevalence of PE, and thus had limited power to estimate diagnostic accuracy (especially sensitivity) or detect an association with a reference standard diagnosis of PE.…”

Section: Literature Reviewmentioning

confidence: 86%

“…In addition to these studies of pregnant and postpartum women with a suspected PE, Kline et al 25 undertook a systematic review of studies of people with suspected PE, which included pregnant and postpartum women. The authors identified 17 studies including 25,399 patients, of whom 506 (2%) were pregnant, with a 4.1% (95% CI 2.6% to 6.0%) prevalence of PE.…”

Section: Literature Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling

Goodacre

Horspool

Shephard

et al. 2018

Health Technol Assess

View full text Add to dashboard Cite

Article:Goodacre, S. orcid.org/0000-0003-0803-8444, Horspool, K., Shephard, N. et al. (8 more authors) (2018) Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling. Health Technology Assessment, 22 (47). ISSN 1366-5278 https://doi.org/10.3310/hta22470 © Queen's Printer and Controller of HMSO 2018. This work was produced by Goodacre et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). HEALTH TECHNOLOGY ASSESSMENTEditorial contact: journals.library@nihr.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health techno...

show abstract

Section: Literature Reviewmentioning

confidence: 86%

Section: Literature Reviewmentioning

confidence: 99%

Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling

Goodacre

Horspool

Shephard

et al. 2018

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…A recent review and meta-analysis showed that the diagnosis of VTE was confi rmed in only 4.1 % of pregnant women, compared with 12.4 % of non-pregnant patients who presented in the emergency unit with the clinical suspicion of PE [103]. To limit the number of radiologic imaging studies in pregnant women, clinical prediction rules, which are an integral part of diagnostic management in the non-pregnant population, might also be desired for pregnant women with suspected VTE.…”

Section: Clinical Pre-test Probabilitymentioning

confidence: 99%

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann¹,

Scholz

Rott

et al. 2016

Vasa

View full text Add to dashboard Cite

EpidemiologyVTE is a leading cause of maternal morbidity in the developed world and, in the case of PE, of mortality as well [1]. While the relative risk of VTE is greatly increased during pregnancy compared with that in non-pregnant women, the absolute risk remains low: estimates of the incidence of pregnancy-associated VTE have varied from 1:500 to 1:1500 pregnancies [2 -7]. The risk of VTE is approximately 5-fold greater in pregnant women than in non-pregnant women.Approximately 80 % of pregnancy-associated VTEs are isolated DVTs, and approximately 20 % are PEs or both DVTs and PEs [5]. Although a systematic review reported weighted event rates for DVT of 21.9 %, 33.7 % and 47.6 % for the fi rst, second and third trimesters, respectively [6], a recent study suggested that the risk might in fact increase exponentially over the duration of the pregnancy [7], with 12.4 % of VTEs diagnosed in the fi rst trimester, 15.3 % in the second trimester and 72.3 % in the third trimester. This detailed risk assessment for each gestational week demonstrated a 21-fold increased risk for the last two weeks before delivery [7]. Summary: Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratory testing and imaging studies for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currently in use have not been prospectively validated in pregnancy or during the postpartum period. D-dimers physiologically increase throughout pregnancy and peak at delivery, so a negative D-dimer test result, based on the reference values of non-pregnant subjects, becomes unlikely in the second and third trimesters. Imaging studies therefore play a major role in confi rming suspected DVT or PE in pregnant women. Major concerns have been raised against radiologic imaging because of foetal radiation exposure, and doubts about the diagnostic value of ultrasound techniques in attempting to exclude isolated iliac vein thrombosis grow stronger as pregnancy progresses. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarise evidence from the available literature and aim to establish a more uniform strategy for diagnosing pregnancy-associated VTE. Review Diagnosis of pregnancy-associated

show abstract

“…A recent meta-analysis demonstrated that this led to a low 4.1% prevalence of VTE among suspected pregnant patients compared with 12.4% in nonpregnant patients. 44 Moreover, many of the common diagnostic tests, including CUS, V-Q lung scan, and CTPA, that have been investigated extensively in nonpregnant patients have not been validated appropriately in pregnancy. Extrapolating results of diagnostic studies of DVT and PE in nonpregnant patients to those who are pregnant may not be correct because of physiologic changes during pregnancy and the possibility of differences in pathophysiology and presentation of VTE in pregnancy.…”

Section: Vte Diagnosis In the Pregnant Patientmentioning

confidence: 99%

Current challenges in diagnostic imaging of venous thromboembolism

Huisman

Klok

2015

Blood

View full text Add to dashboard Cite

Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient. In this review, we present 3 evidence-based patient cases to underline recent developments in the imaging diagnosis of venous thromboembolism.

show abstract

Systematic Review and Meta‐analysis of Pregnant Patients Investigated for Suspected Pulmonary Embolism in the Emergency Department

Abstract: In the ED setting, physicians test for PE in pregnant patients at a low threshold, resulting in a low rate of VTE diagnosis and a RR of VTE that is lower than that for nonpregnant women of childbearing age who are tested for PE in the ED setting.

Cited by 61 publications

References 56 publications

Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling

Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Current challenges in diagnostic imaging of venous thromboembolism

Contact Info

Product

Resources

About