Key result
Unilateral lower limb swelling or deep vein thrombosis was significantly associated with a higher likelihood of pulmonary embolism diagnosis (OR 5.474).
Why the study?
Pulmonary embolism is a critical condition with recognized risk factors, prompting investigation into the significance of traditional risk factors in CTPA requests and the association of request timing with PE occurrence in a regional Australian population.
Do traditional risk factors and the timing of CTPA requests predict the diagnosis of pulmonary embolism in patients undergoing CTPA in a regional emergency department?
Observational (n=434)
No
Do traditional risk factors and the timing of CTPA requests predict the diagnosis of pulmonary embolism in patients undergoing CTPA in a regional emergency department?
Odds Ratio: 5.474 (95% CI 1.776–16.87)
p-value: p=0.003
In a regional Australian emergency department, unilateral lower limb swelling/DVT strongly predicted PE on CTPA, whereas traditional symptoms like shortness of breath did not, highlighting the potential overutilization of CTPA imaging.
Age and unilateral LL swelling/DVT were associated with PE on CTPA; leaves open whether request timing affects diagnostic yield in regional settings.
BACKGROUND: Pulmonary embolism (PE) is a critical condition with various recognized risk factors. This study investigates these factors in a regional Australian population. AIMS: The primary aim is to examine the significance of traditional risk factors in the clinical decision to request a computed tomography pulmonary angiography (CTPA) scan for suspected PE within this population and assess the association between the timing of CTPA requests (office vs. after-hours) and PE occurrence. METHODS: In this single-center retrospective study, we analyzed data from 434 patients undergoing CTPA at Goulburn Valley Health's (GVH) emergency department (ED) between January and August 2022. Covariates included age, clinical indications, and medical background. Statistical tests were applied with a p-value <0.05 indicating significance. RESULTS: Pulmonary embolism was diagnosed in 39 (20.9%) males and 17 (6.9%) females, with a mean age of 65.04 years (SD: 16.11). Univariate regression indicated a positive association between age and PE. Multivariate analysis showed a significant positive association for unilateral lower limb (LL) swelling/deep vein thrombosis (DVT) (OR: 5.474, p=0.003) and a significant negative association for being female (OR: 0.308, p<0.001). Variables such as shortness of breath, tachycardia, syncope, and chest pain were not significantly associated with PE. No association was found between CTPA request time and PE (χ²=0.9535, df=1, p=0.3288). CONCLUSION: Increasing age and unilateral LL swelling/DVT are significantly associated with PE. Some signs and symptoms showed negative or positive odds but were not statistically significant. The timing of CTPA requests did not correlate with PE incidence.
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Uthuman et al. (2023) conducted an observational in Suspected pulmonary embolism (n=434). Unilateral lower limb swelling or deep vein thrombosis vs. Absence of unilateral lower limb swelling or deep vein thrombosis was evaluated on Diagnosis of pulmonary embolism on CTPA (OR 5.474, 95% CI 1.776-16.870, p=0.003). Unilateral lower limb swelling or deep vein thrombosis was significantly associated with a higher likelihood of pulmonary embolism diagnosis (OR 5.474).
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