Key result
A combined scoring system of ECG, shock index, and arterial blood gas analysis predicted severe pulmonary embolism with 58.8% sensitivity and 73.7% specificity, improving specificity over ECG alone.
Why the study?
Does a combined scoring system of ECG, shock index, and arterial blood gas analysis improve the prediction of severe pulmonary embolism compared to ECG alone in patients with PE?
Cross-Sectional (n=53)
Does a combined scoring system of ECG, shock index, and arterial blood gas analysis improve the prediction of severe pulmonary embolism compared to ECG alone in patients with PE?
Adding shock index and arterial blood gas analysis to ECG scoring improves the specificity for predicting severe pulmonary embolism, though with a slight decrease in sensitivity.
May enhance specificity for severe PE risk stratification; leaves open prospective validation before clinical use.
BACKGROUND: Objective diagnosis of severe pulmonary embolism (PE) is obligatory because of its considerable mortality. AIM: To assess the abilities of electrocardiography (ECG) score (sECG) and the newly generated scoring system composed of the scores obtained from arterial blood gas (ABG) analysis and shock index (SI) in addition to sECG in predicting severe PE. MATERIAL AND METHODS: The degree of pulmonary vascular obstruction (sPVO) and the right ventricular dysfunction (RVD) were determined with spiral computed tomography (CT) in 53 consequent patients with PE. Twelve-lead ECG taken within a day of PE event and ABG values were evaluated according to ECG scoring system and original Geneva system, respectively. RESULTS: The mean age of patients was 62.6 ± 13.4 years. Right ventricular dysfunction, sPVO ≥ 50%, hypoxemia, and SI were present in 34 (64.2%), 27 (50.9%), 50 (94.3%), and 22 (41.5%) patients, respectively. The mean sECG, 5.9 ± 5.1, was correlated with sPVO, maximum diameter of right ventricle (RV), and right ventricle to left ventricle (RV/LV) ratio (r = .385, r = .415, and r = .329, respectively). The mean newly generated score was 10.9 ± 5.5 and correlated with sPVO, maximum diameter of RV, and RV/LV ratio (r = .394, r = .483, and r = .393, respectively). Receiver operator characteristic (ROC) curve analyses revealed that sECG ≥ 3.5, s (ECG + SI) ≥ 4.5, and s (ECG + SI + ABG) ≥ 9.5 predict the severe PE patients with 70.6%, 61.8%, 58.8% sensitivities and 52.6%, 63.2%, 73.7% specificities, respectively. CONCLUSION: Adding the scores obtained from SI and ABG to the sECG enhances the specificity of sECG in predicting RVD (+) or severe PE patients, although a lesser degree decreasing in sensitivity may occur.
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Bircan et al. (2009) conducted a cross-sectional in Pulmonary embolism (n=53). Scoring system composed of ECG, shock index, and arterial blood gas analysis vs. ECG score alone was evaluated on Prediction of severe pulmonary embolism. A combined scoring system of ECG, shock index, and arterial blood gas analysis predicted severe pulmonary embolism with 58.8% sensitivity and 73.7% specificity, improving specificity over ECG alone.
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