Age-Adjusted D-dimer Cutoff for Reducing CT Pulmonary Angiography Tests in Elderly Patients With Suspected Pulmonary Embolism

Aims. To study the use of CT pulmonary angiography (CTPA) at Hutt Hospital and investigate the use of pretest probability scoring in the assessment of patients with suspected pulmonary embolism (PE).Methods. We studied patients with suspected PE that underwent CTPA between January and May 2012 and collected data on demographics, use of pretest probability scoring, and use of D Dimer and compared our practice with the British Thoracic Society (BTS) guideline.Results. 105 patients underwent CTPA and 15% of patients had PE. 13% of patients had a Wells score prior to their scan. Wells score calculated by researchers revealed 54%, 36%, and 8% patients had low, medium, and high risk pretest probabilities and 8%, 20%, and 50% of these patients had positive scans. D Dimer was performed in 58% of patients and no patients with a negative D Dimer had a PE.Conclusion. The CTPA positive rate was similar to other contemporary studies but lower than previous New Zealand studies and some international guidelines. Risk stratification of suspected PE using Wells score and D Dimer was underutilised. A number of scans could have been safely avoided by using accepted guidelines reducing resources use and improving patient safety.

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Utilization of CT Pulmonary Angiography in Suspected Pulmonary Embolism in a Major Urban Emergency Department

Pulmonary Medicine ◽

10.1155/2013/915213 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 14

Author(s):

Adil Shujaat ◽

Janet M. Shapiro ◽

Edward Eden

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Clinical Information ◽

Pulmonary Angiography ◽

Suspected Pulmonary Embolism ◽

Ct Pulmonary Angiography ◽

Clinical Probability ◽

Emergency Department Patients ◽

One Year ◽

D Dimer

Objectives. We conducted a study to answer 3 questions: (1) is CT pulmonary angiography (CTPA) overutilized in suspected pulmonary embolism (PE)? (2) What alternative diagnoses are provided by CTPA? (3) Can CTPA be used to evaluate right ventricular dilatation (RVD)?Methods. We retrospectively reviewed the clinical information of 231 consecutive emergency department patients who underwent CTPA for suspected PE over a one-year period.Results. The mean age of our patients was 53 years, and 58.4% were women. The prevalence of PE was 20.7%. Among the 136 patients with low clinical probability of PE, a d-dimer test was done in 54.4%, and it was normal in 24.3%; none of these patients had PE. The most common alternative findings on CTPA were emphysema (7.6%), pneumonia (7%), atelectasis (5.5%), bronchiectasis (3.8%), and congestive heart failure (3.3%). The sensitivity and negative predictive value of CTPA for (RVD) was 92% and 80%, respectively.Conclusions. PE could have been excluded without CTPA in ~1 out of 4 patients with low clinical probability of PE, if a formal assessment of probability and d-dimer test had been done. In patients without PE, CTPA did not provide an alternative diagnosis in 65%. In patients with PE, CTPA showed the potential to evaluate RVD.

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CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00389-7 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Aya Yassin ◽

Maryam Ali Abdelkader ◽

Rehab M. Mohammed ◽

Ahmed M. Osman

Keyword(s):

Pulmonary Embolism ◽

Disease Severity ◽

Laboratory Data ◽

Pulmonary Angiography ◽

Significant Relation ◽

Ct Pulmonary Angiography ◽

Laboratory Results ◽

Severity Of The Disease ◽

The Relationship ◽

D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

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PREDICTIVE VALUES OF THE WELLS AND REVISED GENEVA SCORES COMBINED WITH D-DIMER FOR SUSPECTED PULMONARY EMBOLISM IN ELDERLY PATIENTS

Heart ◽

10.1136/heartjnl-2012-302920y.2 ◽

2012 ◽

Vol 98 (Suppl 2) ◽

pp. E279.3-E280

Author(s):

Zhao Can ◽

Guo Danjie

Keyword(s):

Pulmonary Embolism ◽

Elderly Patients ◽

Suspected Pulmonary Embolism ◽

Predictive Values ◽

D Dimer

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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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