Diagnosing Pulmonary Embolism in Pregnancy: Are Biomarkers and Clinical Predictive Models Useful?
Objective The objective of this study was to evaluate whether trimester-specific D-dimer levels or the modified Wells score (MWS) is a useful risk stratification tool to exclude pregnant women at low risk of pulmonary embolism (PE) from diagnostic imaging. Study Design This is a prospective and retrospective cohort study. Pregnant women who underwent diagnostic imaging for suspected PE were prospectively enrolled. D-dimer serum levels were drawn, and a MWS was assigned. Pregnant women diagnosed with a PE before study launch who underwent diagnostic imaging and had a D-dimer level drawn were also evaluated. Results In this study, 17 patients were diagnosed with a PE and 42 patients had no PE on diagnostic imaging. Sixteen out of 17 patients with a PE versus 11 out of 42 without PE had an abnormal D-dimer level (p = 0.001). Four patients with a PE versus zero without a PE had an abnormal MWS (p = 0.005). The combination of a trimester-specific D-dimer level along with the MWS was abnormal in all 17 patients with a documented PE versus 11/42 (26.2%) patients without a documented PE (p = 0.001). Conclusion A combination of trimester-specific D-dimer levels along with a MWS can be used in pregnancy to triage women into a low-risk category for PE and thereby avoid radiation exposure in a majority of pregnant patients.
Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois.
Barbara V
BV
Parilla
Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois.
Rachel
R
Fournogerakis
Department of Emergency Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois.
Amy
A
Archer
James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, Illinois.
Suela
S
Sulo
Department of Radiology, Advocate Lutheran General Hospital, Park Ridge, Illinois.
Lisa
L
Laurent
Department of Emergency Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Patricia
P
Lee
Department of Emergency Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Benazir
B
Chhotani
Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois.
Kathleen
K
Hesse
Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois.
Erik
E
Kulstad
D-dimer; brain; modified Wells score; natriuretic protein; pregnancy; pulmonary embolism