Chest
Original Research Pulmonary Procedures FeaturedAccuracy of Point-of-Care Multiorgan Ultrasonography for the Diagnosis of Pulmonary Embolism
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Design, Setting, Protocol, and Population
This was a multicenter prospective accuracy study, and the local ethic committees approved the study (No. 2012/20938 and 2012/5069). Written informed consent was obtained for inclusion in the study. The patients were recruited from June 2012 to November 2012 in the ED of three Italian hospitals: two university hospitals with an annual census of 120,000 and 50,000 visits, respectively, and one community hospital with an annual census of 50,000 visits.
Consecutive patients aged > 18 years,
Results
A total of 510 patients with clinically suspected PE presented to the EDs. Ninety-seven patients (19%) had a Wells score ≤ 4 and a negative D-dimer and were not considered for the study. Among the 413 patients with a Wells score > 4 or a positive D-dimer, 56 (13.6%) were excluded because they met exclusion criteria (Fig 1); thus, 357 patients were included. Included patients had a mean age of 71 ± 14 years (range, 19-100 years), and 188 (52.7%) were women. PE was diagnosed by MCTPA in 110
Discussion
This study indicates that multiorgan ultrasonography is feasible in almost all patients presenting to the ED with suspected PE. Multiorgan ultrasonography sensitivity is significantly superior to that of lung, heart, and leg vein ultrasonography alone; our multiorgan protocol may be useful as a routine pretest evaluation to improve the potential of Wells scoring and D-dimer assay in the selection of patients who should undergo MCTPA.
Today, MCTPA has become the standard of care in patients with
Limitations and Conclusions
Multiorgan ultrasonography tests were performed in the ED by emergency physicians with at least 2 years' experience in ultrasonography. Application of the same methodology by physicians with less experience may lower accuracy and safety. Moreover, the accuracy of multiorgan ultrasonography performed in different settings, such as inpatient or outpatient clinics, may be different. Another note is that patients with contraindications to MCTPA were excluded from our study.
Multiorgan
Acknowledgments
Author contributions: Dr Nazerian is the guarantor of the manuscript.
Dr Nazerian: contributed to study conception and design and data acquisition, analysis, and interpretation; drafted the manuscript; edited the manuscript for important intellectual and scientific content; served as the principal author; edited the revision; and approved the final draft.
Dr Vanni: contributed to study conception and design, conducted statistical analysis, drafted the manuscript, edited the revision, and approved
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.
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