RESUMEN
BACKGROUND AND AIMS: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism. MATERIALS AND METHODS: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively. RESULTS: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard d-dimer or age-adjusted d-dimer was used. CONCLUSIONS: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.
Asunto(s)
Productos de Degradación de Fibrina-Fibrinógeno , Embolia Pulmonar , Enfermedad Aguda , Anciano , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Antecedentes y objetivo: Evaluar la frecuencia de tromboembolismo pulmonar agudo (TEPA), el uso de escalas de probabilidad clínica (EPC) y la adecuación del manejo de los pacientes a los que se solicitó angiografía pulmonar por tomografía computarizada (angio-TC) por sospecha de TEPA desde el servicio de urgencias. Materiales y métodos: Estudio observacional retrospectivo de las angio-TC solicitadas desde el servicio de urgencias para descartar TEPA. Se analizaron variables clínicas y el uso explícito de EPC. Se determinó la adecuación del manejo en función de las escalas de Wells (EW) y Ginebra (EG) y sus versiones simplificadas (EWs y EGs), calculadas retrospectivamente. Resultados: Se incluyeron 534 pacientes (52,8% mujeres, mediana de edad: 73 años). La frecuencia de TEPA fue del 23,0% y el uso explícito de la EW, del 15,2%. La adecuación del manejo fue variable dependiendo de la EPC (54,5-75,8%) y del dímero D estándar o ajustado por edad. Conclusiones: La baja utilización explícita de la EW no conlleva un manejo inadecuado, y el juicio clínico global puede ofrecer un rendimiento similar a las EPC, pero es necesario realizar estudios específicos para comprobar esta hipótesis.(AU)
Background and aims: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism. Materials and methods: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively. Results: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard D-dimer or age-adjusted D-dimer was used. Conclusions: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.(AU)
Asunto(s)
Humanos , Femenino , Anciano , Embolia Pulmonar , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico , Urgencias Médicas , Práctica Clínica Basada en la Evidencia , Servicio de Urgencia en Hospital , Manejo de Caso , Angiografía por Tomografía Computarizada , Valor Predictivo de las Pruebas , Radiología , Estudios RetrospectivosAsunto(s)
Vacuna BCG/efectos adversos , Tuberculosis Miliar/etiología , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Administración Intravesical , Anciano , Antituberculosos/uso terapéutico , Vacuna BCG/administración & dosificación , Etambutol/uso terapéutico , Humanos , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Mycobacterium bovis/aislamiento & purificación , Rifampin/uso terapéutico , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológicoRESUMEN
BACKGROUND AND AIMS: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism. MATERIALS AND METHODS: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively. RESULTS: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard D-dimer or age-adjusted D-dimer was used. CONCLUSIONS: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.