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Clinical Investigations: THROMBOEMBOLIC DISEASE |

ECG Score Predicts Those With the Greatest Percentage of Perfusion Defects Due to Acute Pulmonary Thromboembolic Disease*

Stephen Iles, MRCP; Campbell J. Le Heron; Gwyn Davies, MRCP; John G. Turner, MD; Lutz E. L. Beckert, MD, FCCP
Author and Funding Information

*From the Canterbury Respiratory Research Group (Dr. Iles and Mr. Le Heron); and Department of Medicine (Drs. Davies, Turner, and Beckert), Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, Otago, New Zealand.

Correspondence to: Stephen Iles, MRCP, Department of Respiratory Medicine, Royal Cornwall Hospital, Treliske, Cornwall TR4 3LJ, United Kingdom; e-mail: steveiles@doctors.org.uk



Chest. 2004;125(5):1651-1656. doi:10.1378/chest.125.5.1651
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Background: More aggressive management may be warranted for patients with acute pulmonary embolism (PE) and the greatest pulmonary vascular obstruction. We hypothesized that a scoring system based on the ECG might identify such patients.

Methods: Consecutive patients investigated for PE at Christchurch Hospital between 1997 and 2002 with high-probability ventilation/perfusion (V̇/Q̇) scan findings were studied. The ECG obtained closest to and within 48 h of the scan was scored by two independent observers, and the mean ECG score was calculated. V̇/Q̇ scan findings were categorized into those with < 30%, 30 to 50%, and > 50% perfusion defect by two independent observers experienced in V̇/Q̇ interpretation. A consensus score was taken when disagreement occurred.

Results: Two hundred twenty-nine patients were included in the study. The interobserver agreement for ECG score was 0.96 (Cronbach α) and V̇/Q̇ score was 0.55 (κ). The ECG predicted those with the greatest amount of perfusion defects. Mean ECG score was 2.6 (SD 2.8) in patients with < 30% perfusion defect, 3.2 (SD 2.9) in patients with 30 to 50% perfusion defect, and 5.3 (SD 3.7) in patients with > 50% perfusion defect. The area under the receiver operating characteristic curve for ECG score and those with > 50% perfusion defect was 0.71 (SE 0.04). An ECG score of ≥ 3 predicted those with > 50% perfusion defect with a sensitivity of 70% (95% confidence interval [CI], 59 to 81%), and a specificity of 59% (95% CI, 51 to 67%).

Conclusion: An ECG score, simple to derive, predicts those with the greatest percentage of perfusion defect. Using the ECG for management warrants prospective evaluation.

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