Patrick Badertscher1, Jeanne du Fay de Lavallaz2, Angelika Hammerer-Lercher3, Thomas Nestelberger4, Tobias Zimmermann4, Marc Geiger4, Orell Imahorn4, Òscar Miró5, Emilio Salgado5, Michael Christ6, Louise Cullen7, Martin Than8, F Javier Martin-Sanchez9, Salvatore Di Somma10, W Frank Peacock11, Dagmar I Keller12, Juan Pablo Costabel13, Joan Walter4, Jasper Boeddinghaus4, Raphael Twerenbold4, Adriana Méndez3, Boris Gospodinov3, Christian Puelacher14, Desiree Wussler4, Luca Koechlin15, Damian Kawecki16, Nicolas Geigy17, Ivo Strebel4, Jens Lohrmann18, Michael Kühne18, Tobias Reichlin19, Christian Mueller20. 1. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois. Electronic address: https://twitter.com/BadertscherPat. 2. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy. Electronic address: https://twitter.com/JDFDLz. 3. Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland. 4. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy. 5. GREAT network, Rome, Italy; Hospital Clinic, Barcelona, Catalonia, Spain. 6. General Hospital, Paracelsus Medical University, Nürnberg, Germany. 7. GREAT network, Rome, Italy; Royal Brisbane & Women's Hospital, Herston, Queensland, Australia. 8. GREAT network, Rome, Italy; Christchurch Hospital, Christchurch, New Zealand. 9. GREAT network, Rome, Italy; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain. 10. GREAT network, Rome, Italy; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy. 11. GREAT network, Rome, Italy; Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas. 12. University Hospital Zürich, Zürich, Switzerland. 13. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 14. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. 15. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland. 16. GREAT network, Rome, Italy; 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland. 17. Emergency Department, Kantonsspital Liestal, Liestal, Switzerland. 18. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland. 19. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiology, Inselspital Bern, Bern, Switzerland. 20. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy. Electronic address: christian.mueller@usb.ch.
Abstract
BACKGROUND: The prevalence of pulmonary embolism (PE) in patients presenting with syncope to the emergency department (ED) is largely unknown. This information, however, is necessary to balance the potential medical benefit or harm of systematic PE screening in patients presenting with syncope to the ED. OBJECTIVES: This study sought to determine the prevalence of PE in patients with syncope. METHODS: Unselected patients presenting with syncope to the ED were prospectively enrolled in a diagnostic multicenter study. Pre-test clinical probability for PE was assessed using the 2-level Wells score and the results of D-dimer testing using age-adapted cutoffs. Presence of PE was evaluated by imaging modalities, when ordered as part of the clinical assessment by the treating ED physician or by long-term follow-up data. RESULTS: Long-term follow-up was complete in 1,380 patients (99%) at 360 days and 1,156 patients (83%) at 720 days. Among 1,397 patients presenting with syncope to the ED, PE was detected at presentation in 19 patients (1.4%; 95% confidence interval [CI]: 0.87% to 2.11%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.5% to 1.5%). In the subgroup of patients hospitalized (47%), PE was detected at presentation in 15 patients (2.3%; 95% CI: 1.4% to 3.7%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.4% to 2.0%). CONCLUSIONS: PE seems to be a rather uncommon cause of syncope among patients presenting to the ED. Therefore, systematic PE-screening in all patients with syncope does not seem warranted. (BAsel Syncope EvaLuation Study [BASEL IX]; NCT01548352).
BACKGROUND: The prevalence of pulmonary embolism (PE) in patients presenting with syncope to the emergency department (ED) is largely unknown. This information, however, is necessary to balance the potential medical benefit or harm of systematic PE screening in patients presenting with syncope to the ED. OBJECTIVES: This study sought to determine the prevalence of PE in patients with syncope. METHODS: Unselected patients presenting with syncope to the ED were prospectively enrolled in a diagnostic multicenter study. Pre-test clinical probability for PE was assessed using the 2-level Wells score and the results of D-dimer testing using age-adapted cutoffs. Presence of PE was evaluated by imaging modalities, when ordered as part of the clinical assessment by the treating ED physician or by long-term follow-up data. RESULTS: Long-term follow-up was complete in 1,380 patients (99%) at 360 days and 1,156 patients (83%) at 720 days. Among 1,397 patients presenting with syncope to the ED, PE was detected at presentation in 19 patients (1.4%; 95% confidence interval [CI]: 0.87% to 2.11%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.5% to 1.5%). In the subgroup of patients hospitalized (47%), PE was detected at presentation in 15 patients (2.3%; 95% CI: 1.4% to 3.7%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.4% to 2.0%). CONCLUSIONS: PE seems to be a rather uncommon cause of syncope among patients presenting to the ED. Therefore, systematic PE-screening in all patients with syncope does not seem warranted. (BAsel Syncope EvaLuation Study [BASEL IX]; NCT01548352).
Authors: Sudeep K Siddappa Malleshappa; Gautam K Valecha; Tapan Mehta; Smit Patel; Smith Giri; Roy E Smith; Rahul A Parikh; Kathan Mehta Journal: PLoS One Date: 2020-04-13 Impact factor: 3.240