How Accurate Is Gestalt Alone for PE?
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In this individual patient data meta-analysis, researchers found that a positive clinician gestalt was associated with a three times higher rate of pulmonary embolism (PE) compared to negative gestalt.
Source
Accuracy of the Physicians' Intuitive Risk Estimation in the Diagnostic Management of Pulmonary Embolism: An Individual Patient Data Meta-Analysis. J Thromb Haemost. 2023 May 30:S1538-7836(23)00438-5. doi: 10.1016/j.jtha.2023.05.023. Epub ahead of print.
Ugly CTPA, Good PESI Score – Are They Low Risk?
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In a retrospective study of 331 low risk acute pulmonary embolism patients, concerning CTPA findings were not associated with adverse clinical outcomes.
Source
Adverse Clinical Outcomes Among Patients With Acute Low-risk Pulmonary Embolism and Concerning Computed Tomography Imaging Findings. JAMA Netw Open. 2023 May 1;6(5):e2311455. doi: 10.1001/jamanetworkopen.2023.11455.
More Evidence that PERC Works!
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Among patients in the RIETE database with confirmed pulmonary embolism (PE), there was a low failure rate when pulmonary embolism rule-out criteria (PERC) was applied in this retrospective cohort. PERC-negative patients who had PEs were less likely to have proximal PEs, and their rates of cardiopulmonary complications were lower when compared to PERC-positive patients.
Source
Safety of the pulmonary embolism rule-out criteria rule: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. Acad Emerg Med. 2023 Apr 24. doi: 10.1111/acem.14744. Epub ahead of print.
What’s the Risk of VTE After Minor Surgery?
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Some “minor” surgical procedures still carry an increased risk of venous thromboembolism postoperatively.
Source
The risk of venous thromboembolism after minor surgical procedures: A population-based case-control study. J Thromb Haemost. 2023 Apr;21(4):975-982. doi: 10.1016/j.jtha.2022.11.035. Epub 2022 Dec 22.
PE-SARD – Big Fail Predicting Bleeding Risk with PE
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PE-SARD failed to accurately predict risk of major or clinically relevant bleeding in patients ≥65 years with acute PE at 7 days or on longer follow-up.
Source
Prediction of very early major bleeding risk in acute pulmonary embolism: an independent external validation of the PE-SARD Bleeding Score. J Thromb Haemost. 2023 May 4;S1538-7836(23)00347-1. doi: 10.1016/j.jtha.2023.04.025. Online ahead of print.
Low-Risk Acute PE – What Influences Admission Decision?
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In a retrospective cohort of patients with acute pulmonary embolism (PE) and a low pulmonary embolism severity index (PESI) score, increased heart rate and bilateral PE were factors associated with physicians' decision for hospitalization.
Source
Bilateral Emboli and Highest Heart Rate Predict Hospitalization of Emergency Department Patients With Acute, Low-Risk Pulmonary Embolism [published online ahead of print, 2023 Apr 5]. Ann Emerg Med. 2023;S0196-0644(23)00123-3.
PE Workup in Pregnancy – YEARS, Wells, Both, Neither?
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Pregnant patients who present with signs and symptoms concerning for PE can be safely evaluated using Wells criteria or the YEARS algorithm.
Source
Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data. J Thromb Haemost. 2023 Mar;21(3):606-615. doi: 10.1016/j.jtha.2022.11.025. Epub 2022 Dec 22.
Can D-dimer Still Rule Out PE in COVID-19 Patients?
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A negative D-dimer performed similarly in predicting a 30-day risk of pulmonary embolism (PE) regardless of a patient’s COVID-19 status.
Source
Prognostic association between d-dimer thresholds and 30-day pulmonary embolism diagnosis among emergency department patients with suspected SARS-CoV-2 infection: a Canadian COVID-19 Emergency Department Rapid Response Network study. CJEM. 2023 Feb;25(2):134-142. doi: 10.1007/s43678-022-00440-8. Epub 2023 Jan 10.
AHA Statement – Surgical Embolectomy and ECMO for High-Risk PE
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This is a scientific statement from the American Heart Association emphasizing the need for more research on surgical embolectomy and mechanical circulatory support in the treatment of high-risk pulmonary embolism.
Source
Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2023;10.1161/CIR.0000000000001117. doi:10.1161/CIR.0000000000001117
Breaking NEWS – Best PE Scores | NEWS vs. PESI vs. sPESI
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The National Early Warning Score (NEWS) was comparable to the validated Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI) in predicting 7-day ICU admission and 30-day mortality in patients with acute pulmonary embolism (PE).
Source
Use of the National Early Warning Score for predicting deterioration of patients with acute pulmonary embolism: a post-hoc analysis of the YEARS Study. Emerg Med J. 2022 Nov 7:emermed-2021-211506. doi: 10.1136/emermed-2021-211506. Epub ahead of print.