title: Electrocardiographic findings in Emergency Department patients with pulmonary embolism.
abstract: To assess the pre-study, null hypothesis that there is no difference in the electrocardiogram (EKG) findings for Emergency Department (ED) patients who rule in vs. rule out for suspected pulmonary embolism, a retrospective review of a cohort of patients with pulmonary embolism and their controls was conducted in an academic, suburban ED. Patients who were evaluated in the ED during a one-year study period for symptoms suggestive of pulmonary embolism were eligible for inclusion. All patients with pulmonary embolism and sex- and age-matched controls comprised the final study groups. Two board-certified cardiologists reviewed each patient's EKG. There were 350 eligible patients identified; 49 patients with pulmonary embolism and 49 controls were entered into the study. The most common rhythm observed in both groups was normal sinus rhythm (67.3% cases vs. 68.6 % controls; p = 1.0). Abnormalities believed to be associated with pulmonary embolism occurred with similar frequency in both case and control groups (sinus tachycardia [18.8 % vs. 11.8%, respectively; p = 0.40]), incomplete right bundle branch block (4.2% vs. 0.0%, respectively; p = 0.24), complete right bundle branch block (4.2% vs. 6.0, respectively; p = 1.0), S1Q3T3 pattern (2.1 vs. 0.0, respectively; p = 0.49), S1Q3 pattern (0.0 vs. 0.0), and extreme right axis (0.0 vs. 0.0). New EKG changes were identified more frequently for patients with pulmonary embolism (33.3% vs. 12.5% controls; p = 0.03), but specific findings were rarely different between cases and controls. In our cohort of ED patients, we did not identify EKG features that are likely to help distinguish patients with pulmonary embolism from those who rule out for the disease.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Hospital, Scottsdale, Arizona, USA.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Richman
authors.forename: Hassan
authors.initials: H
authors.lastname: Loutfi
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lester
authors.forename: Patricia
authors.initials: P
authors.lastname: Cambell
authors.forename: Jessica
authors.initials: J
authors.lastname: Matthews
authors.forename: Jeremy
authors.initials: J
authors.lastname: Friese
authors.forename: Joseph
authors.initials: J
authors.lastname: Wood
authors.forename: David
authors.initials: D
authors.lastname: Kasper
authors.forename: Frederick
authors.initials: F
authors.lastname: Chen
authors.forename: Mark
authors.initials: M
authors.lastname: Mandell
mesh_terms: D000368:Aged; D001130:Arizona; D015331:Cohort Studies; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies; D013383:Suburban Population