Use of spiral computed tomography contrast angiography and ultrasonography to exclude the diagnosis of pulmonary embolism in the emergency department

Anderson, David R.; Kovacs, Michael J.; Dennie, Carol; Kovács, George; Stiell, Ian G.; Dreyer, Jon; McCarron, B I; Pleasance, Susan; Burton, Erica; Cartier, Yannick; Wells, Philip S.

doi:10.1016/j.jemermed.2005.05.010

Cited by 82 publications

(47 citation statements)

References 18 publications

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“…Too few patients had PEs in the group with D-dimer data to allow a meaningful direct comparison with PET,CO 2 . While our CT positivity rate for PE was lower than some previously published reports [7,8,26], it is similar to other publications in the literature and may represent local practice patterns [21,27]. The PET,CO 2 would likely be abnormal in conditions affecting metabolic activity or CO 2 excretion such as pregnancy, end-stage chronic obstructive lung disease or advanced neuromuscular disease.…”

Section: Clinical Practice Ar Hemnes Et Alsupporting

confidence: 84%

“…Dead space fraction (VD/VT), measured by comparing total exhaled CO 2 tension with arterial CO 2 tension, has previously been shown to be abnormal in PE and VD/VT in combination with D-dimer testing is effective at ruling out PE [11][12][13]21]. However, the requirement of specialised equipment and an arterial puncture limit its widespread adaptation.…”

Section: Clinical Practice Ar Hemnes Et Almentioning

confidence: 99%

See 1 more Smart Citation

Bedside end-tidal CO₂tension as a screening tool to exclude pulmonary embolism

Hemnes¹,

Newman²,

Rosenbaum³

et al. 2009

Eur Respir J

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End tidal carbon dioxide tension (PET,CO 2 ) is a surrogate for dead space ventilation which may be useful in the evaluation of pulmonary embolism (PE). We aimed to define the optimal PET,CO 2 level to exclude PE in patients evaluated for possible thromboembolism. 298 patients were enrolled over 6 months at a single academic centre. PET,CO 2 was measured within 24 h of contrast-enhanced helical computed tomography, lower extremity duplex or ventilation/perfusion scan. Performance characteristics were measured by comparing test results with clinical diagnosis of PE.PE was diagnosed in 39 (13%) patients. Mean PET,CO 2 in healthy volunteers did not differ from PET,CO 2 in patients without PE (36.3¡2.8 versus 35.5¡6.8 mmHg). PET,CO 2 in patients with PE was 30.5¡5.5 mmHg (p,0.001 versus patients without PE). A PET,CO 2 of o36 mmHg had optimal sensitivity and specificity (87.2 and 53.0%, respectively) with a negative predictive value of 96.6% (95% CI 92.3-98.5). This increased to 97.6% (95% CI 93.2-99.) when combined with Wells score ,4.A PET,CO 2 of o36 mmHg may reliably exclude PE. Accuracy is augmented by combination with Wells score. PET,CO 2 should be prospectively compared to D-dimer in accuracy and simplicity to exclude PE.

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Section: Clinical Practice Ar Hemnes Et Alsupporting

confidence: 84%

Section: Clinical Practice Ar Hemnes Et Almentioning

confidence: 99%

Bedside end-tidal CO₂tension as a screening tool to exclude pulmonary embolism

Hemnes¹,

Newman²,

Rosenbaum³

et al. 2009

Eur Respir J

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“…13 Similar strategies can be used in patients with suspected PE. PE can be considered excluded in patients with a negative moderate sensitivity D-dimer test and low pretest probability [33][34][35] and in those with a negative highly sensitive D-dimer and a nonhigh pretest probability. 23,[36][37][38][39][40][41][42] Testing with either computerized tomographic (CT) pulmonary angiography or ventilation-perfusion lung scanning is recommended in patients with a positive D-dimer result and in all patients with a high pretest probability.…”

Section: • Myocardial Infarctionmentioning

confidence: 99%

D-Dimer Assays in Diagnosis and Management of Thrombotic and Bleeding Disorders

Bates

2012

Semin Thromb Hemost

103

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).D-dimer is a global indicator of coagulation activation and fibrinolysis and, therefore, an indirect marker of thrombotic activity. This specific cross-linked fibrin degradation product is formed through the sequential action thrombin, activated factor XIII (FXIIIa), and plasmin (►Fig. 1). 1-3 First, thrombin, generated when coagulation is activated, converts fibrinogen to fibrin and activates FXIII. Second, FXIIIa covalently crosslinks D-domains in adjacent fibrin monomers. Third, plasmin (formed on the fibrin surface by plasminogen activation) cleaves substrate fibrin at specific sites, and when it cleaves fibrin cross-linked by FXIIIa, it generates D-dimer. D-dimer is cleared through the kidneys and the reticuloendothelial system and has a plasma half-life of approximately 8 hours. 4 Low levels of D-dimer can be found circulating under normal physiologic conditions, while pathologically elevated levels can be found in any condition associated with enhanced fibrin formation and fibrinolysis (►Table 1). 1-3 The utility of D-dimer measurement has been evaluated in several clinical situations; however, the D-dimer assays have been best validated for the exclusion of venous thromboembolism (VTE) and the diagnosis and monitoring of disseminated intravascular coagulation (DIC). This article will review the available evidence for the utilization of D-dimer antigen measurement in the management of thrombotic and bleeding disorders. Measurement of D-DimerThe presence of D-dimer in plasma can be detected using monoclonal antibodies that recognize an epitope present in FXIIIa-cross-linked fragment D-domain of fibrin but not in fibrinogen degradation products or noncross-linked fibrin degradation products. Many different D-dimer assays have been developed and marketed. All of these tests rely on the use of monoclonal antibodies to detect D-dimer molecules. In general, three techniques are available to assay D-dimer (►Fig. 2). 1-3 These are (1) enzyme-linked immunosorbent assays (ELISAs) that rely on antibody capture and labeling of D-dimer; (2) a whole-blood agglutination assay (SimpliRED, Siemens Healthcare Diagnostics, Newcastle, DE), that uses a bispecific antibody conjugate with binding sites for both D-dimer and a red cell antigen and is performed on whole blood; (3) latex agglutination assays that also use bispecific antibodies with specificity for the latex particle and D-dimer antigen. Earlier latex agglutination assays for D-dimer were qualitative or semiquantitative; however, newer automated, quantitative D-dimer assays (which are immunoturbidometric assays) are performed on routine, automated coagulation instruments. It is important to recognize that results are not comparable between different assays, even between those of similar formats. Potential reasons for the lack of comparable results are listed in ►Table 2. Numeric results of D-dimerAbstract D-dimer is a global indicator of coagulation activation and fibrinolysis and, therefore, an indirect marker of thrombotic activity. The utility of D-dimer measur...

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“…4). В эти правила включены 3 (низкая, средняя и высокая вероятность ТЭЛА) или 2 категории (вероятная и маловероятная ТЭЛА) [96][97][98][99][100]. Правила просты и основаны на легкодоступной информации.…”

Section: оценка клинической вероятностиunclassified

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

Редакционная¹

2015

Pulʹmonologiâ (Mosk.)

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РезюмеВ данных Клинических рекомендациях суммированы все современные доказательства по диагностике и лечению тромбоэмболии легочной артерии (ТЭЛА). В отличие от предыдущей версии рекомендаций, в данном документе представлены упрощенные варианты клинических прогностических шкал, подробно рассмотрена стратификация риска летального исхода, включая промежуточные степени риска, представлены новые подходы к АКТ, в т. ч. системному тромболизису и катетерным методам лечения, терапии антагонистом витамина К, определено место новых пероральных антикоагулянтов в терапии ТЭЛА. Ключевые слова: рекомендации, тромбоэмболия легочной артерии, венозный тромбоз, шок, гипотензия, торакалгия, одышка, сердеч ная недостаточность, диагностика, антикоагулянты, тромболизис. SummaryThese clinical recommendations summarized currently available evidence on diagnosis and management of patients with pulmonary embolism. When compared to previous version of recommendations, this document has introduced simplified clinical prognostic scales and a new risk stratifi cation system including intermediate risk. Novel approach to anticoagulant therapy have been also reviewed including systemic thrombolysis, catheter directed treatment, vitamin K antagonists and new oral anticoagulants. Key words: recommendations, pulmonary embolism, venous thromboembolism, shock, hypotension, chest pain, dyspnea, heart failure, diagnosis, anticoagulants, thrombolysis.Тромбоэмболия легочной артерии: клинические рекомендации Европейского общества кардиологов (2014) 526Пульмонология. 2015; 25 (5): 525-552 возникавших в ходе работы над Рекомендациями, надлежало информировать ЕОК и вносить соответ ствующие поправки. Финансирование Рабочей груп пы проводилось за счет средств ЕОК полностью, без участия представителей медицинской промышлен ности.Комитетом ЕОК по Практическим рекомендаци ям проведены наблюдение за процессом подготовки новых Клинических рекомендаций и его координа ция. Члены Комитета также несли ответственность за утверждение новых Клинических рекомендаций. Клинические рекомендации ЕОК активно проана лизированы Комитетом по Практическим рекомен дациям и внешними экспертами. После соответст вующих поправок Рекомендации были одобрены всеми экспертами Рабочей группы. Окончательный документ был утвержден Комитетом по Практичес ким рекомендациям для публикации в журнале European Heart Journal.Задача написания Клинических рекомендаций ЕОК заключается не только в объединении результа тов исследований последних лет, но также и в разра ботке образовательных методик и программ внедре ния Рекомендаций в практическое здравоохранение.Для практического использования Рекоменда ций готовится их краткая («карманная») версия, а также слайды, буклеты с ключевыми положения ми, листовки для неспециалистов и электронная версия для смартфонов и других гаджетов (сокра щенные варианты); с полным текст Рекомендаций опубликован на сайте ЕОК и находится в свободном доступе. Национальным обществам рекомендуется утверждать, переводить на национальные языки и внедрять Клинические рекоме...

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Use of spiral computed tomography contrast angiography and ultrasonography to exclude the diagnosis of pulmonary embolism in the emergency department

Cited by 82 publications

References 18 publications

Bedside end-tidal CO₂tension as a screening tool to exclude pulmonary embolism

Bedside end-tidal CO₂tension as a screening tool to exclude pulmonary embolism

D-Dimer Assays in Diagnosis and Management of Thrombotic and Bleeding Disorders

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

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Use of spiral computed tomography contrast angiography and ultrasonography to exclude the diagnosis of pulmonary embolism in the emergency department

Cited by 82 publications

References 18 publications

Bedside end-tidal CO2tension as a screening tool to exclude pulmonary embolism

Bedside end-tidal CO2tension as a screening tool to exclude pulmonary embolism

D-Dimer Assays in Diagnosis and Management of Thrombotic and Bleeding Disorders

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

Contact Info

Product

Resources

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Bedside end-tidal CO₂tension as a screening tool to exclude pulmonary embolism

Bedside end-tidal CO₂tension as a screening tool to exclude pulmonary embolism