The Mortality of Untreated Pulmonary Embolism in Emergency Department Patients

Calder, Kirsten K.; Herbert, Mel; Henderson, Sean O.

doi:10.1016/j.annemergmed.2004.10.001

Cited by 146 publications

(86 citation statements)

References 80 publications

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“…In fact, there is now debate whether pulmonary embolism carries as high of mortality as has previously been suggested [3]. In addition, all pulmonary emboli detected by CTA may not be clinically relevant, especially when they involve only the subsegmental pulmonary arterial branches [7].…”

Section: Discussionmentioning

confidence: 95%

“…Studies have yet to demonstrate that this increased utilization of pulmonary CTA significantly decreases patient morbidity or mortality associated with PE, a disease whose incidence, prevalence and natural history is poorly understood [3]. In fact, the opposite may be true.…”

Section: Introductionmentioning

confidence: 87%

“…Pulmonary CT has its own risks from exposure to ionizing radiation [4,5] and contrast-induced nephropathy [6]. Furthermore, not all PE may be clinically relevant [3,7].…”

Section: Introductionmentioning

confidence: 99%

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Avoiding Unnecessary Pulmonary CT Angiography by Using a Combination of Clinical Criteria and D-Dimer Thresholds

Gimber¹,

Leong²,

Todoki³

et al. 2013

OJRad

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Objective:To evaluate what specific combination of clinical criteria and d-dimer values may yield at least a 10% positive pulmonary embolism (PE) rate in patients undergoing pulmonary CT angiography (CTA). Materials and Methods: Retrospective review of all patients presenting to the Emergency Department with possible PE who underwent pulmonary CTA and had a d-dimer drawn. Wells scores were retrospectively assigned based on data gathered through medical records. Results: During a 29-month period, 1110 patients underwent pulmonary CTA. Of these, 773 also had a d-dimer drawn. These subjects were stratified based on serum d-dimer levels into negative (≤4 µg/ml), nonpositive (0.41 -1.0 µg/ml), or positive (>1.0 µg/ml) d-dimer categories. The prevalence of positive CTA studies was >10% only in the positive d-dimer group. Subjects were also stratified based on their Wells score into three clinical categories: low (score < 2), intermediate (score = 2 -6), and high risk of pulmonary embolism (score > 6). The prevalence of positive CTA was > 10% only in the group of subjects with high clinical risk. When stratified according to both Wells criteria and d-dimer, only those patients with intermediate or high clinical risk combined with a positive d-dimer (>1.0 µg/ml) had a prevalence of positive pulmonary CTA > 10%. By limiting the use of CTA studies to those patients with positive d-dimer values or high clinical risk, 438 (55.4%) patients could have avoided CTA imaging. Conclusion: Utilizing CTA only in patients suspected of PE with a combination of high clinical risk based on a Wells criteria threshold score > 6 and a serum d-dimer cutoff of 1 µg/ml would increase the prevalence of positive pulmonary CTA studies above 10% and avoid a large number of CTA imaging studies.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 87%

See 1 more Smart Citation

Avoiding Unnecessary Pulmonary CT Angiography by Using a Combination of Clinical Criteria and D-Dimer Thresholds

Gimber¹,

Leong²,

Todoki³

et al. 2013

OJRad

View full text Add to dashboard Cite

show abstract

“…Between 1982 and 2003 a total of 20 cases of RM associated with S. pneumoniae infection were described in the literature [5][6][7][8]. In most cases major underlying conditions were identified: alcohol abuse and smoking were the most frequent conditions, while splenectomy was present in three cases [6,9,10].…”

Section: The American College Of Emergency Physician (Acep) 2003 Posimentioning

confidence: 98%

“…The oft-cited untreated PE mortality of 30% originates from nearly irrelevant historical investigations [6]. Reanalyses of untreated or missed PEs in ambulatory patients predict recurrence or mortality closer to 5% [7]. This explains how a single-row detector helical CT scan, which misses 30% of PEs [8], can be useful as a screening test; most PEs are not fatal, many are small, and their mere existence does not ensure a bad outcome.…”

mentioning

confidence: 96%