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Acad Emerg Med. 2016 Nov 12. doi: 10.1111/acem.13130. [Epub ahead of print]

Diagnostic performance of Wells score combined with point-of-care lung and venous ultrasound in suspected pulmonary embolism.

Author information

  • 1Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
  • 2Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy.
  • 3Department of Internal Medicine, University Hospital of Perugia, Perugia, Italy.
  • 4Respiratory Unit, Dipartimento Scienze della Salute, San Paolo Hospital, Universit√† degli Studi di Milano, Milano, Italy.
  • 5Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milano, Italy.

Abstract

OBJECTIVE:

Lung and venous ultrasound are bedside diagnostic tools increasingly used in the early diagnostic approach of suspected pulmonary embolism (PE). However, the possibility of improving the conventional prediction rule for PE by integrating ultrasound has never been investigated.

METHODS:

We performed lung and venous ultrasound in consecutive patients suspected of PE in four emergency departments. Conventional Wells score (Ws) was adjudicated by the attending physician, and ultrasound was performed by one of 20 investigators. Signs of deep venous thrombosis (DVT) at venous ultrasound and signs of pulmonary infarcts or alternative diagnoses at lung ultrasound were considered to re-calculate two items of the Wells score: signs and symptoms of DVT and alternative diagnosis less likely than PE. The diagnostic performances of the ultrasound-enhanced Ws (USWs) and Ws were then compared after confirmation of the final diagnosis.

RESULTS:

446 patients were studied. PE was confirmed in 125 patients (28%). USWs performed significantly better than Ws, with a sensitivity of 69.6% vs 57.6% and a specificity of 88.2% vs 68.2%. In combination with d-dimer, USWs showed an optimal failure rate (0.8%) and a significantly superior efficiency than Ws (32.3% vs 27.2%). A strategy based on lung and venous ultrasound combined with d-dimer would allow to avoid CT pulmonary angiography in 50.5% of patients with suspected PE, compared to 27.2% when the rule without ultrasound is applied.

CONCLUSIONS:

A pre-test risk stratification enhanced by ultrasound of lung and venous performs better than Ws in the early diagnostic process of PE. This article is protected by copyright. All rights reserved.

KEYWORDS:

Pulmonary embolism; Ultrasound; Wells score; diagnosis; prediction rule

PMID:
27859891
DOI:
10.1111/acem.13130
[PubMed - as supplied by publisher]
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