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Latest & greatest articles for pulmonary embolism
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Sex-specific performance of pre-imaging diagnostic algorithms for pulmonaryembolism Essentials Decision rules for pulmonaryembolism are used indiscriminately despite possible sex-differences. Various pre-imaging diagnostic algorithms have been investigated in several prospective studies. When analysed at an individual patient data level the algorithms perform similarly in both sexes. Estrogen use and male sex were associated with a higher prevalence in suspected pulmonary embolism.Background (...) In patients suspected of pulmonaryembolism (PE), clinical decision rules are combined with D-dimer testing to rule out PE, avoiding the need for imaging in those at low risk. Despite sex differences in several aspects of the disease, including its diagnosis, these algorithms are used indiscriminately in women and men. Objectives To compare the performance, defined as efficiency and failure rate, of three pre-imaging diagnostic algorithms for PE between women and men: the Wells rule with fixed or with age
Rapid blood test helps exclude pulmonaryembolism for low risk patients Rapid blood test helps exclude pulmonaryembolism for low risk patients Discover Portal Discover Portal Rapid blood test helps exclude pulmonaryembolism for low risk patients Published on 25 October 2016 doi: An inexpensive blood test can help quickly rule out pulmonaryembolism for low risk patients attending hospital outpatient or emergency departments, especially in people with early symptoms. This review looked (...) diagnostic imaging. Overall a change in the management pathway for suspected pulmonaryembolism (PE) have potential to be cost saving and provide better care. Commissioners, will be interested in the overall pathway costs but unfortunately these were not researched here. Share your views on the research. Why was this study needed? In the UK, 47,734 cases of PE were reported between 2014 and 2015. Emergency admissions for PE increased by 30% between 2008 and 2012. A pulmonaryembolism is a blockage
Combination of PulmonaryEmbolism Rule-out Criteria and YEARS Algorithm in a European Cohort of Patients with Suspected PulmonaryEmbolism Both the YEARS algorithm and the pulmonaryembolism (PE) rule-out criteria (PERC) were created to exclude PE with limited diagnostic tests. A diagnostic strategy combining both scores might save additional computed tomography pulmonary angiography (CTPA) scans, but they have never been evaluated in conjunction.The aim of this study was to determine
Blood and Clots Series: My patient has a pulmonaryembolism. Should I screen them for cancer? Blood and Clots Series: My patient has a pulmonaryembolism. Should I screen them for cancer? - CanadiEM Blood and Clots Series: My patient has a pulmonaryembolism. Should I screen them for cancer? In , by Eric Tseng March 20, 2018 All the content from the Blood & Clots series can be found . CanMEDS Roles addressed: Expert, Leader Case Description An 83 year old female presents for follow-up after
Effect of the PulmonaryEmbolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. The safety of the pulmonaryembolism rule-out criteria (PERC), an 8-item block of clinical criteria aimed at ruling out pulmonaryembolism (PE), has not been assessed in a randomized clinical trial.To prospectively validate the safety of a PERC-based strategy to rule out PE.A crossover cluster-randomized clinical (...) that was not initially diagnosed. The noninferiority margin was set at 1.5%. Secondary end points included the rate of computed tomographic pulmonary angiography (CTPA), median length of stay in the emergency department, and rate of hospital admission.Among 1916 patients who were cluster-randomized (mean age 44 years, 980 [51%] women), 962 were assigned to the PERC group and 954 were assigned to the control group. A total of 1749 patients completed the trial. A PE was diagnosed at initial presentation in 26 patients
Clinical prediction rules for mortality in patients with pulmonaryembolism and cancer to guide outpatient management: a meta-analysis Essentials Clinical prediction rules (CPRs) can stratify patients with pulmonaryembolism (PE) and cancer. A meta-analysis was done to assess prognostic accuracy in CPRs for mortality in these patients. Eight studies evaluating ten CPRs were included in this study. CPRs should continue to be used with other patient factors for mortality risk (...) stratification.Background Cancer treatment is commonly complicated by pulmonaryembolism (PE), which remains a leading cause of morbidity and mortality in these patients. Some guidelines recommend the use of clinical prediction rules (CPRs) to help clinicians identify patients at low risk of mortality and therefore guide care. Objective To determine and compare the accuracy of available CPRs for identifying cancer patients with PE at low risk of mortality. Methods A literature search of Medline and Scopus (January 2000
PulmonaryembolismPulmonaryembolism - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Pulmonaryembolism Last reviewed: February 2019 Last updated: July 2018 Summary Pulmonaryembolism (PE) is a life-threatening condition resulting from dislodged thrombi occluding the pulmonary vasculature; right heart failure and cardiac arrest may ensue if not aggressively treated. Symptoms include chest pain, dyspnoea, and a sense (...) , and supportive care. For those at intermediate risk of a poor outcome, anticoagulation and ongoing monitoring is required and rescue re-perfusion should be considered. Ongoing anticoagulation therapy is indicated to reduce the risk of recurrent events or fatal PE. Definition Pulmonaryembolism (PE) is a consequence of thrombus formation within a deep vein of the body, most frequently in the lower extremities. Thrombus formation in the venous system occurs as a result of venous stasis, trauma
Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism | CADTH.ca Find the information you need Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism Published on: March 1, 2018 Project Number: OP0528-000 Product Line: Research Type: Other Diagnostics Result type: Report Pulmonaryembolism (PE) is a blockage of one of the arteries in the lung (...) as potential environmental impact were also addressed. Tags blood, decision support techniques, diagnostic tests, echocardiography, fibrin fibrinogen degradation products, magnetic resonance imaging, pet scan, perfusion imaging, positron-emission tomography, pulmonaryembolism, radionuclide imaging, spect, tomography, ultrasonography, venous thromboembolism, ct scan, imaging, mri, respiratory, ultrasound, CT angiography, CT pulmonary angiography, CTPA, Emission-Computed, Geneva, MRIs, PERC, PET, PET-CT
Clinical Value of Ultrasonography in Diagnosis of PulmonaryEmbolism in Critically Ill Patients Pulmonaryembolism (PE) is a clinical emergency that will increase the mortality if complicated with unstable hemodynamics. Because of its nonspecific clinical symptoms, it's a great challenge to make a PE diagnosis. The golden standard to diagnose PE is computed tomography of pulmonary artery (CTPA), but a diagnosis of PE also composed of evaluation of PE risk factors, possibilities, and risk (...) stratification. Ultrasonography may detect right ventricle strain related to hemodynamic change, intravascular thrombosis, thrombosis in right heart or pulmonary arteries, pulmonary infarction, and local pleural effusion. Combination of ultrasound and traditional PE possibility evaluation score may further improve the pretest probability of CTPA. A comprehensive ultrasonography may sometimes rule out PE and may disclose other causes for the clinical situations. A heart-lung-vessel-integrated multiorgan
No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonaryembolism Essentials Imaging is warranted in the majority of patients to confirm or rule out pulmonaryembolism (PE). The age-adjusted D-dimer (ADJUST) reduced the number of required imaging tests in patients ≥ 50 years. The YEARS algorithm was designed to improve the efficiency in patients with suspected PE. There was no added value of implementing ADJUST in the YEARS algorithm in our (...) cohort.Background The YEARS algorithm was designed to simplify the diagnostic work-up of pulmonaryembolism (PE) and to reduce the number of necessary computed tomography pulmonary angiography (CTPA) scans. An alternative strategy to reduce the number of CTPAs is the age-adjusted D-dimer cut-off (ADJUST) in patients aged 50 years or older. We aimed to investigate whether a combination of both diagnostic strategies might save additional CTPAs. Methods The YEARS algorithm consists of three items (clinical signs
Blood and Clots Quizlet 1: Oral Contraceptives and PulmonaryEmbolism Blood and Clots Quizlet 1: Oral Contraceptives and PulmonaryEmbolism - CanadiEM Blood and Clots Quizlet 1: Oral Contraceptives and PulmonaryEmbolism In , by Eric Tseng October 27, 2017 Hello Blood & Clots/CanadiEM community! Before we post our blog series on thrombosis and bleeding, we encourage you to test your initial knowledge by going through a few brief case scenarios. These cases were originally posted as part of our (...) to someone who started COC only 3 months prior. In this situation her pre-test probability is driven not by her COC but her clinical presentation. Therefore, it is reasonable to perform a D-Dimer test to exclude pulmonaryembolism as she is low pretest probability. This conservative approach may obviate the need for CT scan and avoid radiation exposure. Question 3: You discover that she has a family history of a hypercoagulable disorder. How does this change management? A) This is highly unlikely
Approaches to Diagnosing Acute PulmonaryEmbolism in Canada: current practice, challenges, and availability of testing Approaches to Diagnosing Acute PulmonaryEmbolism in Canada: current practice, challenges, and availability of testing | CADTH.ca Find the information you need Approaches to Diagnosing Acute PulmonaryEmbolism in Canada: current practice, challenges, and availability of testing Approaches to Diagnosing Acute PulmonaryEmbolism in Canada: current practice, challenges (...) , and availability of testing Published on: September 8, 2017 Project Number: ES0307-000 Product Line: Result type: Report CADTH undertook an environmental scan to identify and summarize information regarding pulmonaryembolism (PE) imaging in Canada. The scan described current practice, challenges, and enablers in diagnosing PE, and the availability of tests, scans, and tools for diagnosing PE. The key objectives of this environmental scan were as follows: Identify current practice related to diagnostic
Assessing clinical probability of pulmonaryembolism: prospective validation of the simplified Geneva score Essentials The simplified Geneva score allows easier pretest probability assessment of pulmonaryembolism (PE). We prospectively validated this score in the ADJUST-PE management outcome study. The study shows that it is safe to manage patients with suspected PE according to this score. The simplified Geneva score is now ready for use in routine clinical practice.Background Pretest (...) probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonaryembolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva score (SGS) and comparison
Pulmonaryembolism prognostic factors and length of hospital stay: A cohort study Patients with pulmonaryembolism (PE) are commonly admitted to hospital for their initial treatment. We aimed to assess the association of length of hospital stay with commonly available clinical variables and their combinations.A retrospective multicenter cohort study was conducted on consecutive PE patients admitted to eight Italian centers. Logistic regression analysis was performed to evaluate the association (...) between the length of hospital stay and the PulmonaryEmbolism Severity Index (PESI) parameters, National Early Warning Score (NEWS) and other possible determinants.We enrolled 391 patients, with a median hospital stay of 10days (IQR 7-14). Among PESI parameters, only oxygen saturation <90% was significantly associated with length of hospital stay at univariable analysis (OR 1.99; 95% CI 1.3-3.2). At multivariable analysis, NEWS ≥5 was associated with prolonged hospitalization (OR 3.14; 95% CI 1.2-8.3
Lixiana (edoxaban) - for the prevention of embolism in patients with nonvalvular atrial fibrillation OR treatment of deep vein thrombosis (DVT) and pulmonaryembolism (PE) and prevention of recurrent DVT and PE. Lixiana (edoxaban) × Insert searchphrase to search the website Insert searchphrase to search the website > > > Lixiana (edoxaban) Conclusion Lixiana (edoxaban) is the fourth Non-vitamin K Oral Anticoagulant (NOAC) in Denmark after Eliques (apixaban), Xarelto (rivaroxaban) and Pradaxa (...) (dabigatran). Lixiana is indicated for the prevention of embolism in patients with nonvalvular atrial fibrillation (NVAF) with one or more risk factors and treatment of deep vein thrombosis (DVT) and pulmonaryembolism (PE) and prevention of recurrent DVT and PE. For either indication, Lixiana is not inferior to warfarin when it comes to preventing embolism and has a statistically significantly lower occurrence of major bleeding. The lower risk of bleeding is particularly evident in comparisons
Derivation and Validation of a Novel Prediction Model to Identify Low-Risk Patients With Acute PulmonaryEmbolism Accurate identification of low-risk patients with acute pulmonaryembolism (PE) who may be eligible for outpatient treatment or early discharge can have substantial cost-saving benefit. The purpose of this study was to derive and validate a prediction model to effectively identify patients with PE at low risk of short-term mortality, right ventricular dysfunction, and other nonfatal
D-dimer Interval Likelihood Ratios for PulmonaryEmbolism The objective was to estimate D-dimer interval likelihood ratios (iLRs) for diagnosing pulmonaryembolism (PE).The authors used pooled patient-level data from five PE diagnostic management studies to estimate iLRs for the eight D-dimer intervals with boundaries 250, 500, 750, 1,000, 1,500, 2,500, and 5,000 ng/mL. Logistic regression was used to fit the data so that an interval increase corresponds to increasing the likelihood ratio