title: European and American suspected and confirmed pulmonary embolism populations: comparison and analysis.
abstract: BACKGROUND
  If the prevalence of pulmonary embolism (PE) differs significantly between the US and Europe, this observation could reduce the generalizability of diagnostic protocols for PE derived in either location.
  
  
  OBJECTIVE
  To determine possible causes and potential clinical consequences of these PE prevalence differences.
  
  
  METHODS
  Secondary analysis of three prospectively collected multicenter samples (two French and one from the US) including 3174 European and 7940 American PE-suspected patients in Emergency departments (ED) (117 for Europe and 12 for US). Comparison of clinical features, resource use and outcomes of European- and US-suspected PE populations in ED.
  
  
  RESULTS
  European patients evaluated for PE were significantly older and had a higher clinical pretest probability (CPP) for PE. The final PE prevalence was significantly higher in Europe, in the overall sample (26.5% vs. 7.6%) and in each level of CPP. Suspected European patients categorized as low CPP had a higher posttest probability than US low CPP patients. Suspected US patients categorized as high CPP had a much lower posttest probability of PE than in Europe. The mean number of tests performed for one PE diagnosis was lower in Europe (7.4 vs. 21.6). Among patients diagnosed with PE, European patients had a higher mean severity of illness score and a higher PE-mortality rate (3.4% vs. 0.7%).
  
  
  CONCLUSIONS
  Among patients suspected of a PE and those ultimately diagnosed with a PE, European patients had higher acuity, a higher pretest probability and worse outcome than US patients. The present study underscores the importance of disease prevalence for pretest probability scoring approaches and for significance interpretation of imaging tests.
authors.affiliation: Emergency Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Belgium, France. andrea.penaloza@uclouvain.be
authors.forename: A
authors.initials: A
authors.lastname: Penaloza
authors.forename: J
authors.initials: J
authors.lastname: Kline
authors.forename: F
authors.initials: F
authors.lastname: Verschuren
authors.forename: D M
authors.initials: DM
authors.lastname: Courtney
authors.forename: F
authors.initials: F
authors.lastname: Zech
authors.forename: B
authors.initials: B
authors.lastname: Derrien
authors.forename: B
authors.initials: B
authors.lastname: Vielle
authors.forename: A
authors.initials: A
authors.lastname: Armand-Perroux
authors.forename: F
authors.initials: F
authors.lastname: Thys
authors.forename: P-M
authors.initials: PM
authors.lastname: Roy
mesh_terms: D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003955:Diagnostic Tests, Routine; D005060:Europe / Q000453:epidemiology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D