Pulmonary embolism severity before and during the COVID-19 pandemic

Objectives: Early in the coronavirus 2019 (COVID-19) pandemic, a high frequency of pulmonary embolism was identified. This audit aims to assess the frequency and severity of pulmonary embolism in 2020 compared to 2019. Methods: In this retrospective audit, we compared computed tomography pulmonary angiography (CTPA) frequency and pulmonary embolism severity in April and May 2020, compared to 2019. Pulmonary embolism severity was assessed with the Modified Miller score and the presence of right heart strain was assessed. Demographic information and 30-day mortality was identified from electronic health records. Results: In April 2020, there was a 17% reduction in the number of CTPA performed and an increase in the proportion identifying pulmonary embolism (26%, n = 68/265 vs 15%, n = 47/320, p < 0.001), compared to April 2019. Patients with pulmonary embolism in 2020 had more comorbidities (p = 0.026), but similar age and sex compared to 2019. There was no difference in pulmonary embolism severity in 2020 compared to 2019, but there was an increased frequency of right heart strain in May 2020 (29 vs 12%, p = 0.029). Amongst 18 patients with COVID-19 and pulmonary embolism, there was a larger proportion of males and an increased 30 day mortality (28% vs 6%, p = 0.008). Conclusion: During the COVID-19 pandemic, there was a reduction in the number of CTPA scans performed and an increase in the frequency of CTPA scans positive for pulmonary embolism. Patients with both COVID-19 and pulmonary embolism had an increased risk of 30-day mortality compared to those without COVID-19. Advances in knowledge: During the COVID-19 pandemic, the number of CTPA performed decreased and the proportion of positive CTPA increased. Patients with both pulmonary embolism and COVID-19 had worse outcomes compared to those with pulmonary embolism alone.

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Use of Computed Tomography Pulmonary Angiography for Suspected Pulmonary Embolism in Patients with Malignancy- a Single Center Experience

Blood ◽

10.1182/blood.v128.22.5907.5907 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5907-5907

Author(s):

Sravanthi Ravulapati ◽

Cerena K Leung ◽

Mudresh R Mehta ◽

Kara M Christopher ◽

Susan K. Woelich ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Pulmonary Embolism ◽

Conflicts Of Interest ◽

Tertiary Care ◽

Pulmonary Angiography ◽

Screening Tools ◽

Intermediate Risk ◽

Computed Tomography Pulmonary Angiography ◽

Increased Risk

Abstract Background: Pulmonary embolism (PE) is a potentially lethal condition commonly suspected in patients with malignancy. Computed Tomography Pulmonary Angiography (CTPA) is increasingly used in the diagnosis of PE, and guidelines have incorporated various screening tools including the Modified Geneva and Wells criteria to facilitate exclusion of pulmonary embolism. There is an increased risk of venous thromboembolism in patients with active malignancy and therefore an increased suspicion in patients who present to the emergency department (ED) with concerning symptoms. Methods: This is a retrospective analysis at a single tertiary care institution. All patients initially diagnosed with an active malignancy since 2005 and underwent a CTPA between January 2010 and October 2015 were reviewed. Patients were excluded if the CTPA was performed in the setting of trauma, a history of benign malignancy, or if the diagnosis of malignancy was made subsequent to the CTPA. Data collected included patient demographics, clinical presentation, type of malignancy and treatment regimen received. The modified Geneva and Wells criteria were applied to all patients independent from the initial ED risk assessment for a PE. Results: There were 796 patient records reviewed, of which 162 patients met inclusion criteria. Out of these 162 patients, only 8 (4.9%) were found to have a pulmonary embolism. All patients with a positive CTPA had an intermediate risk per the Geneva criteria while only 62.5% had an intermediate risk per the Wells criteria. Of the 154 patients with a negative CTPA, 71.5% and 78.7% had an intermediate risk; 22.5% and 18.7% were classified as low risk based on Wells and Geneva criteria, respectively. The median age of patients was 59 years old, and the majority were male (58%). The most common malignancies in which a CTPA was ordered were lung cancer (27.7%) followed by breast cancer (14.9%) and prostate cancer (6.8%). Despite a negative CTPA, 82 out of 154 patients (53%) were admitted to the hospital. Conclusion: Pulmonary embolism is commonly associated with and frequently suspected in patients with active malignancy. The incidence of PE over a 5-year period in oncology patients was 5% in our emergency department. In total, 18.7% to 22.5% of patients could have avoided a CTPA if scoring was based on the Wells or Geneva criteria. Based on the review at our institution, the modified Geneva and Wells criteria are not adequate, and a new tool needs to be developed for risk stratification for the diagnosis of PE specifically in patients with active malignancy. Disclosures No relevant conflicts of interest to declare.

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Serial use of existing clinical decisions aids can reduce computed tomography pulmonary angiography for pulmonary embolism

Internal and Emergency Medicine ◽

10.1007/s11739-021-02703-1 ◽

2021 ◽

Author(s):

Robert Russell Ehrman ◽

Adrienne Nicole Malik ◽

Reid Kenneth Smith ◽

Zeid Kalarikkal ◽

Andrew Huang ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Pulmonary Angiography ◽

Clinical Decisions ◽

Computed Tomography Pulmonary Angiography

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Early Pulmonary Embolism Detection from Computed Tomography Pulmonary Angiography Using Convolutional Neural Networks

2020 Joint 9th International Conference on Informatics, Electronics & Vision (ICIEV) and 2020 4th International Conference on Imaging, Vision & Pattern Recognition (icIVPR) ◽

10.1109/icievicivpr48672.2020.9306659 ◽

2020 ◽

Author(s):

Ching-Yuan Yu ◽

Yun-Chien Cheng ◽

Chin Kuo

Keyword(s):

Computed Tomography ◽

Neural Networks ◽

Pulmonary Embolism ◽

Convolutional Neural Networks ◽

Pulmonary Angiography ◽

Computed Tomography Pulmonary Angiography

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On multislice computed tomography pulmonary angiography and ventilation/perfusion scanning for the diagnostic work-up of suspected pulmonary embolism

European Journal of Internal Medicine ◽

10.1016/j.ejim.2010.09.009 ◽

2011 ◽

Vol 22 (1) ◽

pp. 122-123

Author(s):

Javier Galipienzo ◽

Julio Flores ◽

Jaime García de Tena

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Multislice Computed Tomography ◽

Pulmonary Angiography ◽

Suspected Pulmonary Embolism ◽

Computed Tomography Pulmonary Angiography ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

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CORRELATION OF D-DIMER LEVEL WITH THE PRESENCE AND SEVERITY OF PULMONARY EMBOLISM ON COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY

10.36106/ijsr/1421349 ◽

2020 ◽

pp. 33-34

Author(s):

Mantavya Patel ◽

Sanjay Paliwal ◽

Rachit Saxena

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Early Diagnosis ◽

Pulmonary Angiography ◽

Clinical Suspicion ◽

Early Prediction ◽

Computed Tomography Pulmonary Angiography ◽

Negative Prediction ◽

D Dimer

Introduction: Early diagnosis of pulmonary embolism can reduce morbidity and motility. D-dimer is well known parameter having high negative prediction value. This study focused on role of D-dimer in early prediction of presence and severity of pulmonary embolism. Material and Methods: Thirty patients with clinical suspicion of pulmonary embolism along with high D-dimer value were included in this study. All selected patients underwent computed tomography pulmonary angiography assessment. D-dimer value was correlated with presence and proximity of pulmonary embolism. Results: Out of thirty selected patients 50% had pulmonary embolism on computed tomography pulmonary angiography assessment. D-dimer value correlated well with presence and proximity of pulmonary embolism. Conclusion: D-dimer value more than 4000 ng/ml had high positive prediction value (79%) in suspected clinical cases. Value more than 8000 ng/ml further improve value to nearly 100% in suspected cases.

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Interobserver Agreement Between On-Call Radiology Residents and Radiology Specialists in the Diagnosis of Pulmonary Embolism using Computed Tomography Pulmonary Angiography

Journal of Computer Assisted Tomography ◽

10.1097/rct.0b013e3181a2f7fa ◽

2009 ◽

Vol 33 (6) ◽

pp. 952-955 ◽

Cited By ~ 5

Author(s):

Johannes W. Verweij ◽

Herman M.A. Hofstee ◽

Richard P. Golding ◽

Jan-Hein T.M. van Waesberghe ◽

Yvo M. Smulders

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Interobserver Agreement ◽

Pulmonary Angiography ◽

Computed Tomography Pulmonary Angiography ◽

Radiology Residents

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Diagnosis of acute Pulmonary Embolism

Hämostaseologie ◽

10.5482/hamo-17-07-0023 ◽

2018 ◽

Vol 38 (01) ◽

pp. 11-21 ◽

Cited By ~ 2

Author(s):

Helia Robert-Ebadi ◽

Marc Righini

Keyword(s):

Pulmonary Embolism ◽

Cost Effective ◽

Pulmonary Angiography ◽

Suspected Pulmonary Embolism ◽

Computed Tomography Pulmonary Angiography ◽

Diagnostic Algorithms ◽

Effective Diagnosis ◽

Management Algorithms ◽

Special Patient ◽

D Dimer

SummaryDuring the last three decades, considerable advances in the management of patients with suspected pulmonary embolism (PE) have improved diagnostic accuracy and made management algorithms safer, easier to use and well standardized. These diagnostic algorithms are mainly based on the assessment of clinical pretest probability, D-Dimer measurement and imaging tests, mainly computed tomography pulmonary angiography (CTPA). These diagnostic algorithms allow a safe and cost-effective diagnosis for most patients with suspected PE.In this review, we discuss current existing evidence for PE diagnosis, the challenge of diagnosing PE in special patient populations, as well as novel imaging tests for PE diagnosis.

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