Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs

Methodology: 2.5/5           Usefulness: 3/5 Daley JI, et al. Acad Emerg Med 26 (11), 1211-1220 Nov 2019 Questions and methods: In patients with abnormal vital signs, what is the sensitivity of FOCUS for the diagnosis of PE? Prospective, multicenter, observational study. Findings: 136 patients with pending CTPE, subdivided in (1) HR≥100 BPM and/or sBP <90 mmHg, […]

Pulmonary Embolism in Pregnancy: Diagnostic Dilemmas

Epidemiology of pulmonary embolism in pregnancy The rate of pulmonary embolism (PE) in pregnancy is 5.4 per 10 000 pregnancies. This is 5x the risk of the general non-pregnant female population The rates of venous thromboembolism change throughout pregnancy: Antepartum: 5.4 per 10 000 Peripartum: 7.2 per 10 000 Postpartum: 4.3 per 10 000 This leads to 0.96 deaths per 100 […]

Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability

Methodology Score: 4/5 Usefulness Score: 4.5/5 Kearon C, et al. N Engl J Med. 2019 Nov 28;381(22):2125-2134 Question and Methods: the authors sought to demonstrate safety using a d-dimer cut-off of 1000ng/mL for low pre-test probability patients & a cut-off of 500ng/mL for moderate pre-test probability patients. Findings: Of 1325 patients with low or moderate pre-test probability and negative corresponding […]

Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism

Journal Club Summary Methodology Score: 4.5/5 Usefulness Score: 4.5 /5 van der Pol LM, et al. N Engl J Med. 2019 Mar 21;380(12):1139-1149 Question and Methods: Using a prospective cohort study of 510 pregnant women, the authors were trying to see whether an algorithm could safely diagnose PEs and avoid unnecessary imaging. Findings: YEARS algorithm can safely rule out PE […]

Fibrinolysis in Acute Pulmonary Embolism

Systemic fibrinolysis (SF) in acute pulmonary embolism (PE) remains a hot topic in acute care medicine. This post will examine the available literature regarding the use of SF in different subtypes of PE. Before examining the literature, we first must review the relevant nomenclature. Defining PE The American Heart Association (AHA) defines “massive” pulmonary embolism as an acute PE that […]

Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study

Journal Club Summary Reference: Van der Hulle T, et al. Lancet. 2017 Jul 15;390(10091):289-297.  Methodology Score: 4/5                   Usefulness Score: 3.5/5 Questions and Methods: This multicenter trial implemented the YEARS simplified algorithm for suspected PE at 12 Netherlands sites in over 3000 patients. Findings: The algorithm was safe (0.61% had VTE), and effective at reducing CTPA by 14% when compared to […]

Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope.

Journal Club Summary Methodology Score: 3.5/5               Usefulness Score:  2/5 Prandoni P, et al. N Engl J Med. 2016 Oct 20;375(16):1524-1531.   Full Article   This cross-sectional multi-center study of Italian patients admitted after an ED presentation for syncope found a 17.1% pulmonary embolism (PE) rate among admitted patients and 3.8% among all-comers to the ED. These results are in stark contrast to […]

Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT” Trial)

Journal Club Summary Methodology Score: 3.5/5               Usefulness Score: 1.5/5   Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M; “MOPETT” Investigators. Am J Cardiol. 2013 Jan 15;111(2):273-7   Article Link   This single-center, open label, randomized control trial found that administration of half-dose tPA in patients with “moderate” pulmonary embolus resulted in a significant reduction in pulmonary artery systolic […]