Pulmonary Vascular Disease |

Chest Radiographs Can Minimize the Use of Computed Tomography of the Chest When Combined With Screening Scores for Pulmonary Embolism Evaluation FREE TO VIEW

Genese Lamare*, MD; A. Shorr, MD; Chee Chan, MD
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Washington Hospital Center, Washington, DC

Chest. 2012;142(4_MeetingAbstracts):853A. doi:10.1378/chest.1390845
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Published online


SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Computed tomography of the chest for pulmonary embolism (CTPE) is frequently used in emergency departments (ED) for patients with respiratory complaints. We theorized that the combination of formal screening scores, such as the Pulmonary Embolism Rule-out Criteria (PERC), the revised Geneva score (RGS), coupled with chest radiographs (CXR) would optimize PE diagnosis in the ED.

METHODS: We performed a retrospective cohort study of consecutive ED patients who underwent CTPE (January - June 2010). We retrospectively scored PERC and RGS. RGS was considered low probability (LP) if <4. CXRs were evaluated and findings were dichotomized into those representing potential alternate diagnoses (pulmonary edema, consolidation, pleural effusion) and all others. We compared the ability of scoring tools alone (PERC and RGS) and then in combination with CXR findings (PERC+CXR, RGS+CXR) to exclude PE. Area under the receiver operating characteristic curves (AUROCs) and negative predictive values (NPVs) served as endpoints.

RESULTS: The cohort included 776 subjects (mean age: 50.6 + 16.5 years; female: 71.6%; 6.6% diagnosed with PE) and 58.8% (n=456) had a concurrent CXR. In the entire cohort, PERC was LP in 22.9% and RGS was LP in 41.0%. Among non-LP PERC patients, 7.9% had a PE compared to 8.7% of non-LP patients by RGS (p=0.61). NPVs were similar (97.8% for PERC, 96.5% for RGS). The rate of PE in LP RGS patients was 3.5% vs 2.2% for PERC (p=0.45). When CXR demonstrated an alternative diagnosis, 5.5% were still diagnosed with PE compared to 5.7% without alternative diagnoses (p=0.93). When either RGS or PERC was LP and CXR showed an alternate diagnosis, no subject had a PE. The AUROCs for PERC and RGS were 0.71 vs 0.63, respectively. When CXR was added to PERC and RGS, AUROCs were similar.

CONCLUSIONS: RGS and PERC have similar diagnostic yield for PE. When combined with radiographic findings for alternative diagnoses, both PERC and RGS can safely rule out PE.

CLINICAL IMPLICATIONS: When PERC or RGS are low probability with a concomitant CXR demonstrating an alternative diagnosis, the likelihood for PE is low. Such screening tools can be used to exclude PE and minimize use of CTPE in the ED.

DISCLOSURE: The following authors have nothing to disclose: Genese Lamare, A. Shorr, Chee Chan

No Product/Research Disclosure Information

Washington Hospital Center, Washington, DC




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