| American Thoracic Society Documents: An Official American Thoracic Society/Society of Thoracic Radiology Clinical Practice Guideline--Evaluation of Suspected Pulmonary Embolism in Pregnancy. | |
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MedLine Citation:
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PMID: 22282185 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background: Pulmonary embolism (PE) is a leading cause of maternal mortality in the developed world. Along with appropriate prophylaxis and therapy, prevention of death from PE in pregnancy requires a high index of clinical suspicion followed by a timely and accurate diagnostic approach. Methods: To provide guidance on this important health issue, a multidisciplinary panel of major medical stakeholders was convened to develop evidence-based guidelines for evaluation of suspected pulmonary embolism in pregnancy using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. In formulation of the recommended diagnostic algorithm, the important outcomes were defined to be diagnostic accuracy and diagnostic yield; the panel placed a high value on minimizing cumulative radiation dose when determining the recommended sequence of tests. Results: Overall, the quality of the underlying evidence for all recommendations was rated as very low or low with some of the evidence considered for recommendations extrapolated from studies of the general population. Despite the low quality evidence, strong recommendations were made for three specific scenarios: performance of chest radiography (CXR) as the first radiation-associated procedure; use of lung scintigraphy as the preferred test in the setting of a normal CXR; and performance of computed-tomographic pulmonary angiography (CTPA) rather than digital subtraction angiography (DSA) in a pregnant woman with a nondiagnostic ventilation-perfusion (V/Q) result. Discussion: The recommendations presented in this guideline are based upon the currently available evidence; availability of new clinical research data and development and dissemination of new technologies will necessitate a revision and update. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11114045/-/DC1 © American Thoracic Society, 2011. |
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Authors:
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Ann N Leung; Todd M Bull; Roman Jaeschke; Charles J Lockwood; Phillip M Boiselle; Lynne M Hurwitz; Andra H James; Laurence B McCullough; Yusuf Menda; Michael J Paidas; Henry D Royal; Victor F Tapson; Helen T Winer-Muram; Frank A Chervenak; Dianna D Cody; Michael F McNitt-Gray; Christopher D Stave; Brandi D Tuttle; |
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Publication Detail:
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Type: JOURNAL ARTICLE |
Journal Detail:
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Title: Radiology Volume: 262 ISSN: 1527-1315 ISO Abbreviation: - Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-1-27 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401260 Medline TA: Radiology Country: - |
Other Details:
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Languages: ENG Pagination: 635-646 Citation Subset: - |
Affiliation:
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This Official American Thoracic Society statement was approved by the ATS Board of Directors, March 2011, and by the Society of Thoracic Radiology, May 2011. This clinical practice guideline has been formally endorsed by the American College of Obstetricians and Gynecologists. This article originally appeared in American Journal of Respiratory and Critical Care Medicine (2011; 184:1200-1208and is reprinted here with permission from the American Thoracic Society. |
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