Abstract Background Pulmonary embolism (PE) is the third most common cardiovascular disease, and a potentially fatal disease with a mortality rate of around 30% if not treated. For the early diagnosis of patients with suspected PE, algorithms are developed that incorporate clinical symptom score systems and clinical and laboratory evaluation data, while high risk patients undergo Computed Tomography Pulmonary Angiography (CTPA) to confirm or rule out disease. Objective We aimed to exclude PE in patients admitted to the Emergency Department (ED) with suspected disease symptoms, using a calibrated detection scale based on clinical laboratory parameters. Material and Methods This single-center retrospective study included 110 patients. Demographics, symptoms, laboratory tests and CTPA results were collected. Based on the above results, a new calibrated scale for PE was developed, consisting of 7 variables (inflammatory index-CRP), prothrombin time, the International Normalized Ratio-INR, Activated Partial Thromboplastin Time-APTT, fibrin degradation products-D-dimer, systolic blood pressure-SBP, oxygen saturation). Based on the CTPA results, patients were categorized into two groups: PE patients and non-PE patients. Subsequently, the relationship of possible PE and patients presented to the ED with suspicious symptoms was evaluated using a new scale and a multivariate logistic regression model controlling for gender, age, smoking, dyspnea, chest pain. Results The mean age of patients was 67±15 years. Our findings show that 21(19%) patients were diagnosed with PE by CTPA, and 89 (81%) patiens were not diagnosed with PE. In addition, 47.6% of PE-patients were over 80 years of age, while 13.5% of non-PE patients were over 80. According to gender, 61.9% of PE-patients were women. Regarding the PE detection scale, 21 non-pE patients (23.6%) had a total scale below 2, while 47.6% of PE-patients had a total score above 5. For each of the PE-escalation categories, the statistically significant level of PE was approximately 7-fold higher in patients with suspected PE symptoms, weighted be the other factors in the model OR=6.88, 95%CI: 2.17-21.85, p=0.001. Conclusions The PE screening scale for patients who first arrive in ED with symptoms suggestive of PE has been developed to help clinicians decide which patients should be referred to CTPA and to avoid patient overload in emergency rooms. Based on this scale, patients with suspicious PE symptoms and a scale value of 0-1 do not have PE as determined by the CTPA, and 50% of patients with PE determined by the CTPA have a scale value greater than 5, and are considered to have pathological findings.
Sigala et al. (Fri,) studied this question.