A pilot calibrated clinical-laboratory scale effectively stratified pulmonary embolism risk, with each escalation category increasing the odds of PE approximately 7-fold (OR 6.88; 95% CI 2.17-21.85; p=0.001).
Observational (n=110)
No
Does a pilot calibrated clinical-laboratory scale accurately rule out pulmonary embolism in emergency department patients with suspected PE?
A novel 7-point clinical-laboratory scale may safely rule out pulmonary embolism in low-risk emergency department patients, potentially reducing unnecessary CTPA imaging.
Odds Ratio: 6.88 (95% CI 2.17–21.85)
p-value: p=0.001
Abstract Introduction Pulmonary embolism (PE) is the third most common cardiovascular disease and is associated with high mortality if left untreated. In large emergency departments (ERs), extensive use of computed tomography pulmonary angiography (CTPA) may lead to significant delays in patient flow and overcrowding. Purpose Our aim was to develop a pilot calibrated clinical-laboratory scale for PE rule-out in the ER. Methods We developed a pilot calibrated scale with scores ranging from 0 (lowest risk) to 7 points (highest risk) including seven clinical and laboratory variables (C-reactive protein-CRP, prothrombin time, international normalized ratio-INR, activated partial thromboplastin time-APTT, fibrin degradation products-D-dimers, systolic blood pressure-SBP, and oxygen saturation-Sp02). Patients with suspected PE representing to a single-center ER were retrospectively analyzed. Demographic, clinical, laboratory, and CTPA data were collected. Patients were classified as PE or non-PE based on CTPA results, and multivariate logistic regression was used to evaluate the association between scale score and PE diagnosis. Results In this single-center retrospective study 110 patients were enrolled, with mean age 67±15 years. PE was confirmed by CTPA in 21 patients (19%), while 89 patients (81%) constituted the non-PE group. Scale scores were strongly associated with PE diagnosis (p=0.001). Notably, no patient with a low scale score (2) was diagnosed with PE, indicating effective rule-out in this subgroup. In contrast, nearly half of patients with high scores (≥5) had confirmed PE. 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. Conclusion This pilot calibrated scale demonstrates promising performance for PE risk stratification and early rule-out in the ER. These findings are consisted with current ESC guidelines, which emphasize rule-out strategies to reduce unnecessary CTPA in suspected PE. However, further validation in larger prospective studies is necessary.
Sigala et al. (Wed,) conducted a observational in Suspected pulmonary embolism (n=110). Pilot calibrated clinical-laboratory scale was evaluated on Pulmonary embolism diagnosis confirmed by CTPA (OR 6.88, 95% CI 2.17-21.85, p=0.001). A pilot calibrated clinical-laboratory scale effectively stratified pulmonary embolism risk, with each escalation category increasing the odds of PE approximately 7-fold (OR 6.88; 95% CI 2.17-21.85; p=0.001).