Background: Computed tomography (CT) pulmonary angiography use has increased dramatically, raising concerns for patient safety. Adherence to recommendations and guidelines may protect patients. We measured adherence to the recommendations of Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED II) investigators for evaluation of suspected pulmonary embolism and the rate of potential false-positive pulmonary embolism diagnoses when recommendations of PIOPED II investigators were not followed.
Methods: We used a structured record review to identify 3500 consecutive CT pulmonary angiograms performed to investigate suspected pulmonary embolism in 2 urban emergency departments, calculating the revised Geneva score (RGS) to classify patients as "pulmonary embolism unlikely" (RGS≤10) or "pulmonary embolism likely" (RGS>10). CT pulmonary angiograms were concordant with PIOPED II investigator recommendations if pulmonary embolism was likely or pulmonary embolism was unlikely and a highly sensitive D-dimer test result was positive. We independently reviewed 482 CT pulmonary angiograms to measure the rate of potential false-positive pulmonary embolism diagnoses.
Results: A total of 1592 of 3500 CT pulmonary angiograms (45.5%) followed the recommendations of PIOPED II investigators. The remaining 1908 CT pulmonary angiograms were performed on patients with an RGS≤10 without a D-dimer test (n=1588) or after a negative D-dimer test result (n=320). The overall rate of pulmonary embolism was 9.7%. Potential false-positive diagnoses of pulmonary embolism occurred in 2 of 3 patients with an RGS≤10 and a negative D-dimer test result.
Conclusions: Nonadherence to recommendations for CT pulmonary angiography is common and exposes patients to increased risks, including potential false-positive diagnoses of pulmonary embolism.
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http://dx.doi.org/10.1016/j.amjmed.2012.05.028 | DOI Listing |
N Engl J Med
January 2025
Itabashi Chuo Medical Center, Tokyo, Japan
JAMA Netw Open
January 2025
Department of Emergency Medicine, University of California Davis, Davis.
JAMA Netw Open
January 2025
Department of Emergency Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield.
Importance: Despite guideline recommendations to use low-molecular-weight heparins (LMWHs) or direct oral anticoagulants in the treatment of most patients with acute pulmonary embolism (PE), US-based studies have found increasing use of unfractionated heparin (UFH) in hospitalized patients.
Objective: To identify barriers and facilitators of guideline-concordant anticoagulation in patients hospitalized with acute PE.
Design, Setting, And Participants: This qualitative study conducted semistructured interviews from February 1 to June 3, 2024, that were recorded, transcribed, and analyzed in an iterative process using reflexive thematic analysis.
JVS Vasc Insights
January 2024
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh.
Objective: The aim of this study was to review the most commonly used percutaneous mechanical thrombectomy devices for the treatment of pulmonary embolism today.
Methods: A thorough search of the existing literature was conducted on commonly used percutaneous mechanical thrombectomy devices, most notably Inari Flowtriever, Penumbra's Indigo Aspiration, and Alphavac. Reported qualitative and quantitative information was abstracted and descriptively reviewed to ascertain the clinical utility and effectiveness of these devices.
Cureus
December 2024
Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, USA.
Sjogren's syndrome is an autoimmune condition characterized by infiltration of exocrine glands but, in rare cases, can have extraglandular involvement with pleural effusion being an exceedingly rare form. Here we present a case of Sjogren's pleuritis resulting in pleural effusion, a rare initial presentation for Sjogren's syndrome. A woman in her 20s presented to the emergency department after a recent hospitalization for pneumonia, pleural effusion, and pulmonary embolism.
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