Diagnosis of pulmonary embolism in hospitalised patients: retrospective survey of an institutional standard.
The aim of the present study was to assess the safety and implementation of a diagnostic strategy in hospitalised patients with suspected acute pulmonary embolism (PE). A diagnostic strategy was established and implemented in a general hospital. A retrospective cohort study, including 400 consecutive in-patients, was performed in order to assess the appropriateness of the diagnostic management and the incidence of symptomatic venous thromboembolic events (VTE) during follow-up. PE was confirmed in 116 (29%) patients. The incremental value of adding compression ultrasonography (CUS) to multidetector-row computed tomography (MDCT) for the diagnosis of PE was 8.6%. PE was appropriately excluded in 169 (42%) patients due to a normal lung scan (n = 34), a negative MDCT providing an alternative diagnosis (n = 94), and a negative MDCT and CUS (n = 41). During follow-up, VTE occurred in 3.5% patients. The almost unique cause of inappropriate management was the absence of further work-up after a MDCT-negative result for PE providing no alternative diagnosis (n = 115). Inappropriate management was associated with a nonsignificant increased risk of VTE (7.2%). A frontline diagnostic work-up based on pulmonary multidetector-row computed tomography associated with a compression ultrasonography of the leg veins is effective and more sensitive than pulmonary multidetector-row computed tomography alone in ruling out pulmonary embolism.
Jouveshomme
S
S
Pneumology and Thoracic Oncology Service, CHI Poissy-St Germain, 20, rue d'Armagis, 78100 St Germain-en-Laye, France. stephanejouveshomme@chi-psg.com
Bohn
I
I
Cazaban
A
A
D000368:Aged; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D012985:Software Design; D016896:Treatment Outcome