What question did this study set out to answer?

To evaluate how appropriately diagnostic guidelines are implemented for suspected pulmonary embolism in routine emergency care and assess the relationship between guideline adherence and clinical outcomes.

February 7, 2006Annals of Internal Medicine

Appropriateness of Diagnostic Management and Outcomes of Suspected Pulmonary Embolism

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Why the study?

Does appropriate diagnostic management according to international guidelines reduce thromboembolic events in outpatients with suspected pulmonary embolism?

Population

1529 consecutive outpatients with suspected pulmonary embolism presenting to 117 emergency departments

Comparison

Appropriate diagnostic management according to… vs Inappropriate diagnostic management

Design

Cohort

Follow-up

3 months

Authors

PRPierre‐Marie RoyVascular Medicine GMGuy MeyerVascular Medicine BVBruno VielleUniversité d'Angers

Discussion

Member takes

Implication

Appropriate diagnostic management may lower thromboembolic risk in suspected PE; supports guidelines yet leaves open need for randomized confirmation.

Key Points

To evaluate how appropriately diagnostic guidelines are implemented for suspected pulmonary embolism in routine emergency care and assess the relationship between guideline adherence and clinical outcomes.
Prospective cohort study conducted across 116 emergency departments in France and 1 in Belgium, enrolling 1,529 consecutive outpatients with suspected pulmonary embolism.
Tracked diagnostic management appropriateness according to international guidelines and followed patients for 3 months to monitor thromboembolic events.
Diagnostic management was inappropriate in 43% (662/1,529) of patients, including 8% (36/429) with confirmed pulmonary embolism and 57% (626/1,100) in whom pulmonary embolism was ruled out.
Independent risk factors for inappropriate evaluation included age older than 75 years (adjusted OR 2.27, 95% CI 1.48–3.47), pregnancy (OR 5.92, 95% CI 1.81–19.30), active anticoagulation (OR 4.57, 95% CI 2.51–8.31), and the lack of an emergency department diagnostic algorithm (OR 2.54, 95% CI 1.51–4.28).
Among non-anticoagulated patients, 3-month thromboembolic events occurred in 7.7% (39/506) receiving inappropriate management versus 1.2% (5/418) receiving appropriate management (absolute risk difference 6.5 percentage points, 95% CI 4.0–9.1; P < 0.001; adjusted OR 4.29, 95% CI 1.45–12.70).

Structured PICO

Does appropriate diagnostic management according to international guidelines reduce thromboembolic events in outpatients with suspected pulmonary embolism?

Population

1529 consecutive outpatients with suspected pulmonary embolism presenting to 117 emergency departments

Intervention

Appropriate diagnostic management according to international guidelines

Comparator

Inappropriate diagnostic management (not adhering to international guidelines)

Outcome

Incidence of thromboembolic events during 3-month follow-uphard clinical

Failure to adhere to international diagnostic guidelines for suspected pulmonary embolism is common and independently associated with a significantly increased risk of subsequent thromboembolic events.

Limitations

Observational study without evaluation of the risk for overdiagnosis

Cite This Study

Roy et al. (2006) studied this question.

synapsesocial.com/papers/6a7d2d95ff1a536db837d239 https://doi.org/10.7326/0003-4819-144-3-200602070-00003

Topics

Pulmonary embolism

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Implication

Appropriate diagnostic management may lower thromboembolic risk in suspected PE; supports guidelines yet leaves open need for randomized confirmation.

Appropriateness of Diagnostic Management and Outcomes of Suspected Pulmonary Embolism

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Appropriateness of Diagnostic Management and Outcomes of Suspected Pulmonary Embolism

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

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Topics

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