PULMONARY EMBOLISM IN AN EMERGENCY CARE UNIT: EVALUATION OF PREDICTIVE FACTORS FROM CLINICAL HISTORY AND PHYSICAL EXAM

Eugenia Hopps, Giuseppa Graceffa, Davide Noto, Maurizio Averna, Baldassare Canino, Antonina Giammanco, Caterina Urso, Salvatore Vieni, Emanuela Fertitta, Rosario Squatrito, Martino Tinaglia, Vincenzo Paternò, Francesco Brocato, Rosario Squatrito, Antonella Maria Cardella, Emanuela Fertitta, Martino Tinaglia, Vincenzo Maria Paterno'

Risultato della ricerca: Articlepeer review

Abstract

Objective: An early diagnosis of pulmonary embolism (PE) improves outcome. Therefore, PE should be diagnosed in Emergency Care Units (ECU) at admission. Clinical algorithms support the clinician in this task, although performance is biased by differences in risk factors prevalent in different populations. The clinical conditions predictive of PE were evaluated in subjects from Southern Italy accessing ECU for dyspnea/chest pain.Methods: Retrospective clinical data were obtained by electronic retrieving from a hospital database. Data from 8177 patients (age 18-90 years, 54 with PE) were collected from years 2007-2013.Results: Previous history of PE, thrombosis and/or phlebitis, rheumatic diseases, respiratory failure, low blood pressure, pulse oxymetry rate (SpO2) and high heart rate were associated with PE diagnosis. High white blood count with neutrophilia, C reactive protein, D-dimer, NT-pro-BNP determinations, but not troponin T, were associated with PE. Recalibration of the GENEVA score and its modification, by inclusion of novel risk factors, improved the algorithm performance (GENEVA AROC=0.730, modified GENEVA AROC = 0.792, DeLong's test p=<0.001).Conclusions: PE risk factors in a large Sicilian sample are similar to those of other populations. Data from clinical history and clinical features present at admission were used to recalibrate the PE diagnostic algorithm showing that PE predictive power improved by fitting local data into the predictive model.
Lingua originaleEnglish
pagine (da-a)1857-1863
Numero di pagine7
RivistaActa Medica Mediterranea
Volume32
Stato di pubblicazionePublished - 2016

All Science Journal Classification (ASJC) codes

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