A Pulmonary Embolism Diagnostic Strategy in Patients Hospitalized for COPD Exacerbation—Reply

JAMA ◽  
2022 ◽  
Vol 327 (2) ◽  
pp. 184
Author(s):  
David Jiménez ◽  
Alvar Agustí ◽  
Behnood Bikdeli
Keyword(s):  
Pulmonary Embolism ◽  
Diagnostic Strategy ◽  
Copd Exacerbation

Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation

JAMA ◽  
2021 ◽  
Vol 326 (13) ◽  
pp. 1277
Author(s):  
David Jiménez ◽  
Alvar Agustí ◽  
Eva Tabernero ◽  
Luis Jara-Palomares ◽  
Ascensión Hernando ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Outcomes ◽  
Diagnostic Strategy ◽  
Copd Exacerbation

scholarly journals A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism

2006 ◽  
Vol 260 (5) ◽  
pp. 459-466 ◽  
Author(s):  
M. J. H. A. KRUIP ◽  
M. SÖHNE ◽  
M. NIJKEUTER ◽  
H. M. KWAKKEL-VAN ERP ◽  
L. W. TICK ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Hospitalized Patients ◽  
Diagnostic Strategy ◽  
Suspected Pulmonary Embolism

Prevalence Of Pulmonary Embolism In COPD Patients Hospitalized For An Unexplained Wheezing COPD Exacerbation

2012 ◽  
Author(s):  
Claire Andrejak ◽  
Claire Poulet ◽  
Estelle Hoguet ◽  
Eline Magois ◽  
Marine Gosset ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Copd Exacerbation ◽  
Copd Patients

scholarly journals Incidence and Impact of Pulmonary Embolism During Severe COPD Exacerbation

2019 ◽  
Vol 64 (12) ◽  
pp. 1531-1536 ◽  
Author(s):  
Mohamed Fekih Hassen ◽  
Nejla Tilouche ◽  
Oussama Jaoued ◽  
Souheil Elatrous
Keyword(s):  
Pulmonary Embolism ◽  
Copd Exacerbation ◽  
Severe Copd

Performance of magnetic resonance angiography in suspected acute pulmonary embolism

2005 ◽  
Vol 93 (03) ◽  
pp. 503-511 ◽  
Author(s):  
Abdelouahab Bellou ◽  
Francis Guillemin ◽  
Philippe Douek ◽  
Marie-Claude Laprévote-Heully ◽  
Denis Wahl ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Spiral Ct ◽  
Diagnostic Value ◽  
Pulmonary Angiography ◽  
Observer Agreement ◽  
Prospective Clinical Study ◽  
Diagnostic Strategy ◽  
Clinical Probability

SummaryPulmonary embolism (PE) is a common and potentially fatal disorder. Non-specific findings make the clinical diagnosis of PE difficult. To assess the diagnostic value and inter-observer agreement of magnetic resonance angiography (MRA) in a cohort of patients with suspected PE, we conducted a prospective clinical study. MRA was compared for sensitivity and specificity to a diagnostic strategy including clinical probability, D-dimer testing, spiral CT, ultrasound leg compression and pulmonary angiography. A total of 89 patients with clinically suspected PE were included: the clinical probability of PE was intermediate or high in 78, and low in the remaining 11. All patients underwent mono-or multi-slice spiral CT and MRA with gadolinium injection (both within 24 hours of entry to the study). Anticoagulation was withheld in patients concerned about the strategy. All subjects were followed up for 3 months. MRA was read independently by two experienced teams of radiologists: one local and one from another university centre. Spiral CT was positive in 62 of 63 cases of confirmed PE. No patient with negative CT findings was positive ultrasonographically. Only one patient with a negative CT (and negative ultrasound) had a recurrent thromboembolic event. The first team diagnosed PE with MRA in 47 cases, with a sensitivity of 71% and a specificity of 92%; the second team obtained the diagnosis in 23 cases, with a sensitivity of 31% and a specificity of 85%. Inter-observer agreement between MRA reading was low: Kappa = 0.16 (-0.01 to 0.33); p = 0.07. In conclusion, compared with a non-invasive strategy based on spiral CT, the diagnostic value of MRA is limited by poor inter-observer agreement.

Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries

2005 ◽  
Vol 93 (05) ◽  
pp. 982-988 ◽  
Author(s):  
Alain Cazanave ◽  
Marie Elias ◽  
Valérie Chabbert ◽  
Henri Juchet ◽  
Hélène Paradis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Clinical Assessment ◽  
Lower Limb ◽  
Pulmonary Arteries ◽  
Ct Scans ◽  
Helical Computed Tomography ◽  
Diagnostic Strategy ◽  
Clinical Probability ◽  
D Dimer

SummaryThe objective of the study was to assess the clinical validity of a non-invasive diagnostic strategy for acute pulmonary embolism using clinical assessment combined with both ELISA D-dimer and complete lower limb ultrasound (US) examination of proximal and distal veins, before single-detector helical computed tomography (CT) of pulmonary arteries. We expected the strategy to have a high diagnostic exclusion power and to safely decrease the number of CT scans. This prospective, multicenter outcome study included 274 consecutive outpatients. All underwent a priori clinical probability, D-dimer and bilateral complete lower limb US assessments. Only patients with a high clinical probability and both tests negative, or positive D-dimer and negative US assessments, underwent CT. This was deemed necessary in 114 patients (42%). At baseline, venous thromboembolism (VTE) was detected in 110 patients (40%), either by US showing proximal (n=65) or distal (n=36) thrombosis, or by CT (n=9). Anticoagulant was withheld in the remaining patients with negative results in both D-dimer and US but a non-high clinical probability (n=59), or in both US and CT (n=90), or with negative US (n=6) and inadequate CT (n=9). All patients underwent a three-month clinical follow-up. VTE occurred in one patient with inadequate CT, yielding an incidence of 0.6% [95% confidence interval: 0.1–3.4]. No patient died from VTE or had major bleeding. Using clinical probability, ELISA D-dimer and complete US before helical CT is a safe strategy resulting in a substantial reduction in CT scans.

scholarly journals Pulmonary embolism in patients with chronic hypoxemia

2010 ◽  
Vol 63 (7-8) ◽  
pp. 492-496 ◽  
Author(s):  
Lidija Ristic ◽  
Milan Rancic ◽  
Tatjana Pejcic
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Predictive Value ◽  
Diagnostic Study ◽  
Diagnostic Strategy ◽  
Radiological Findings ◽  
Group I ◽  
Perfusion Scan ◽  
Group Ii ◽  
Chronic Hypoxemia

Introduction. The aim of this prospective, originally designed, clinical - diagnostic study including 200 chronic hypoxemic patients was to assess the possibility of implementation of noninvasive diagnostic strategy and to investigate the incidence of pulmonary embolism and parameters of diagnostic accuracy of radiological findings according to Shintz criteria, echocardiography, lung perfusion scanning according to PIOPED criteria. Material and methods. The study included 200 chronic hypoxemic patients divided into 2 groups, the group I consisting of 42 women and 58 men and the group II consisting of 48 women and 52 men. Results and conclusion. Out of 200 hypoxemic patients, 49 patients (24.5%) were found to have pulmonary embolism. In the group I of 100 patients (42 women and 58 men) with chronic hypoxemia and secondary erythrocytosis the diagnosis of pulmonary embolism was confirmed in 39%, that being statistically significantly different (p<0.001) from 100 patients (48 women and 52 men) in the group II with chronic hypoxemia without secondary erythrocytosis, where pulmonary embolism was found in 10% of the patients. The predictive value was positive for direct radiological signs in 92.3% of patients in the group I for PTE, for indirect ones in 74.35%, and in the group II it was positive for direct radiological signs in 60% and for indirect ones in 90%. The predictive value of perfusion scan was positive in 59% of the group I and in only 22% of the group II. The predictive value for high pressure in the pulmonary artery was positive in 93.7% of the group I and in 66.6% of the group II. The following were found to be a variable predictor: hypoxemia, enlargement of the pulmonary artery, peripheral oligemia and elevation of diaphragm. Logistic regression according to backward - conditional method showed that the chronic hypoxemic patients with secondary erythrocytosis, who had radiological sign of peripheral oligemia - Westermark sign, had 2.286 times higher probability of having pulmonary embolism than similar patients without this sign.

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