Document Detail


Clinical prediction of pulmonary embolism in respiratory emergencies.
MedLine Citation:
PMID:  21396683     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: The initial management of suspected pulmonary embolism (PE) is commonly done in respiratory departments, but is based on clinical prediction rules developed in other settings. OBJECTIVE: To determine the accuracy of established prediction rules for PE in patients with respiratory emergencies. DESIGN: A prospective study MATERIALS AND METHODS: Patients presenting to respiratory emergency department with acute symptoms and signs suggestive of PE (n=183) and subsequently admitted to hospital were prospectively enrolled. Wells' rule, original and revised Geneva scores, their components separately, and other common clinical parameters were recorded during admission. PE was diagnosed by perfusion lung scanning, computed tomographic pulmonary angiography, lower limb venous ultrasonography, magnetic resonance pulmonary angiography, and/or pulmonary angiography. RESULTS: PE was confirmed in 52 and ruled out in 131 patients. Tachycardia, atelectasis, elevated hemidiaphragm, clinical signs of deep-venous thrombosis, physician perception that PE is the likeliest diagnosis, previous thromboembolism, chest pain, and absence of chronic obstructive pulmonary disease or cough were associated with the presence of PE. These significant parameters could be combined for accurate pre-test PE prediction, with a newly devised combinatorial tool exhibiting the highest area under curve [0.92 (95% CI: 0.87-0.97)], followed by Wells' rule [0.86 (95% CI 0.79-0.92)], the revised Geneva score [0.83 (95% CI 0.77-0.90)], and the original Geneva score [0.75 (95% CI 0.68-0.83)]. CONCLUSION: Wells' rule and the revised Geneva score are more useful in diagnosing PE in respiratory emergencies. A newly devised prediction tool can be of even greater accuracy in this patient population.
Authors:
Angeliki M Tsimogianni; Nikoletta Rovina; Ilias Porfyridis; Ioanna Nikoloutsou; Charis Roussos; Spyros G Zakynthinos; Georgios T Stathopoulos
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-9
Journal Detail:
Title:  Thrombosis research     Volume:  -     ISSN:  1879-2472     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ltd. All rights reserved.
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