Peiman Nazerian1, Simone Vanni2, Giovanni Volpicelli3, Chiara Gigli2, Maurizio Zanobetti2, Maurizio Bartolucci4, Antonio Ciavattone5, Alessandro Lamorte3, Andrea Veltri6, Andrea Fabbri5, Stefano Grifoni2. 1. Department of Emergency Medicine, Careggi University Hospital, Firenze. Electronic address: pnazerian@hotmail.com. 2. Department of Emergency Medicine, Careggi University Hospital, Firenze. 3. Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino. 4. Radiology Department, Careggi University Hospital, Firenze. 5. Department of Emergency Medicine, Pierantoni Morgagni Hospital, Forlì. 6. Radiology Department, San Luigi Gonzaga University Hospital, Torino, Italy.
Abstract
BACKGROUND: Presenting signs and symptoms of pulmonary embolism (PE) are nonspecific, favoring a large use of second-line diagnostic tests such as multidetector CT pulmonary angiography (MCTPA), thus exposing patients to high-dose radiation and to potential serious complications. We investigated the diagnostic performance of multiorgan ultrasonography (lung, heart, and leg vein ultrasonography) and whether multiorgan ultrasonography combined to Wells score and D-dimer could safely reduce MCTPA tests. METHODS:Consecutive adult patients suspected of PE and with a Wells score > 4 or a positive D-dimer result were prospectively enrolled in three EDs. Final diagnosis was obtained with MCTPA. Multiorgan ultrasonography was performed before MCTPA and considered diagnostic for PE if one or more subpleural infarcts, right ventricular dilatation, or DVT was detected. If multiorgan ultrasonography was negative for PE, an alternative ultrasonography diagnosis was sought. Accuracies of each single-organ and multiorgan ultrasonography were calculated. RESULTS:PE was diagnosed in 110 of 357 enrolled patients (30.8%). Multiorgan ultrasonography yielded a sensitivity of 90% and a specificity of 86.2%, lung ultrasonography 60.9% and 95.9%, heart ultrasonography 32.7% and 90.9%, and vein ultrasonography 52.7% and 97.6%, respectively. Among the 132 patients (37%) with multiorgan ultrasonography negative forPE plus an alternative ultrasonographic diagnosis or plus a negative D-dimer result, no patients received PE as a final diagnosis. CONCLUSIONS: Multiorgan ultrasonography is more sensitive than single-organ ultrasonography, increases the accuracy of clinical pretest probability estimation in patients with suspected PE, and may safely reduce the MCTPA burden. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01635257; URL: www.clinicaltrials.gov.
RCT Entities:
BACKGROUND: Presenting signs and symptoms of pulmonary embolism (PE) are nonspecific, favoring a large use of second-line diagnostic tests such as multidetector CT pulmonary angiography (MCTPA), thus exposing patients to high-dose radiation and to potential serious complications. We investigated the diagnostic performance of multiorgan ultrasonography (lung, heart, and leg vein ultrasonography) and whether multiorgan ultrasonography combined to Wells score and D-dimer could safely reduce MCTPA tests. METHODS: Consecutive adult patients suspected of PE and with a Wells score > 4 or a positive D-dimer result were prospectively enrolled in three EDs. Final diagnosis was obtained with MCTPA. Multiorgan ultrasonography was performed before MCTPA and considered diagnostic for PE if one or more subpleural infarcts, right ventricular dilatation, or DVT was detected. If multiorgan ultrasonography was negative for PE, an alternative ultrasonography diagnosis was sought. Accuracies of each single-organ and multiorgan ultrasonography were calculated. RESULTS: PE was diagnosed in 110 of 357 enrolled patients (30.8%). Multiorgan ultrasonography yielded a sensitivity of 90% and a specificity of 86.2%, lung ultrasonography 60.9% and 95.9%, heart ultrasonography 32.7% and 90.9%, and vein ultrasonography 52.7% and 97.6%, respectively. Among the 132 patients (37%) with multiorgan ultrasonography negative for PE plus an alternative ultrasonographic diagnosis or plus a negative D-dimer result, no patients received PE as a final diagnosis. CONCLUSIONS: Multiorgan ultrasonography is more sensitive than single-organ ultrasonography, increases the accuracy of clinical pretest probability estimation in patients with suspected PE, and may safely reduce the MCTPA burden. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01635257; URL: www.clinicaltrials.gov.
Authors: P H Mayo; R Copetti; D Feller-Kopman; G Mathis; E Maury; S Mongodi; F Mojoli; G Volpicelli; M Zanobetti Journal: Intensive Care Med Date: 2019-08-15 Impact factor: 17.440
Authors: P Mayo; R Arntfield; M Balik; P Kory; G Mathis; G Schmidt; M Slama; G Volpicelli; N Xirouchaki; A McLean; A Vieillard-Baron Journal: Intensive Care Med Date: 2017-03-07 Impact factor: 17.440
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