Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3652
Rishi K. Gupta, K. Philip, T. Harris
Introduction: Early mortality from intermediate-high risk pulmonary embolism (PE) remains high. Full-dose thrombolysis reduces mortality at 7 days, but increases major bleeding, and does not reduce pulmonary hypertension incidence. An alternative approach may be ‘half-dose’ thrombolysis, which is not known to increase bleeding risk vs. anticoagulation alone. Our hospital protocol includes consideration of half-dose thrombolysis (alteplase 50mg) for intermediate-high risk PE. We describe a case-series of patients presenting with intermediate-high risk PE, aiming to assess the safety, outcomes and patient selection for half-dose thrombolysis. Methods: Records of medical admissions were reviewed retrospectively to identify cases of PE (1/3/15-28/2/17). Intermediate-high risk PE was defined according to ESC guidance. Results: 120 patients had confirmed PEs; 36 were intermediate-high risk. Of these, 22 received half-dose thrombolysis. Of those thrombolysed, median age was 40 years. All 22 were normotensive, had an sPESI score >1, and evidence of right heart strain on CT and/or echocardiogram (median troponin 80ng//L; median D-dimer 7.61mg/L). All 22 thrombolysed patients survived with no significant bleeding (median length of stay 5 days). No patients had evidence of CTEPH at follow-up. Among the 14 patients with intermediate-high risk PE who were not thrombolysed, reasons documented included age, clinical stability, and bleeding risks. Conclusions: Half-dose thrombolysis has appeared safe in our case-series, though careful patient selection is required. Further evaluation of half-dose thrombolysis to reduce early haemodynamic collapse in intermediate-high risk PE may be warranted.
{"title":"Half-dose thrombolysis for intermediate-high risk pulmonary embolism: Case series from a London hospital","authors":"Rishi K. Gupta, K. Philip, T. Harris","doi":"10.1183/13993003.congress-2019.pa3652","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3652","url":null,"abstract":"Introduction: Early mortality from intermediate-high risk pulmonary embolism (PE) remains high. Full-dose thrombolysis reduces mortality at 7 days, but increases major bleeding, and does not reduce pulmonary hypertension incidence. An alternative approach may be ‘half-dose’ thrombolysis, which is not known to increase bleeding risk vs. anticoagulation alone. Our hospital protocol includes consideration of half-dose thrombolysis (alteplase 50mg) for intermediate-high risk PE. We describe a case-series of patients presenting with intermediate-high risk PE, aiming to assess the safety, outcomes and patient selection for half-dose thrombolysis. Methods: Records of medical admissions were reviewed retrospectively to identify cases of PE (1/3/15-28/2/17). Intermediate-high risk PE was defined according to ESC guidance. Results: 120 patients had confirmed PEs; 36 were intermediate-high risk. Of these, 22 received half-dose thrombolysis. Of those thrombolysed, median age was 40 years. All 22 were normotensive, had an sPESI score >1, and evidence of right heart strain on CT and/or echocardiogram (median troponin 80ng//L; median D-dimer 7.61mg/L). All 22 thrombolysed patients survived with no significant bleeding (median length of stay 5 days). No patients had evidence of CTEPH at follow-up. Among the 14 patients with intermediate-high risk PE who were not thrombolysed, reasons documented included age, clinical stability, and bleeding risks. Conclusions: Half-dose thrombolysis has appeared safe in our case-series, though careful patient selection is required. Further evaluation of half-dose thrombolysis to reduce early haemodynamic collapse in intermediate-high risk PE may be warranted.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90501325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1463
Akane Sasaki, Rika Suda, N. Tanabe, Ryogo Ema, Keiko Yamamoto, H. Miwa, A. Naito, H. Kasai, T. Jujo, T. Sugiura, Naoko Kawata, S. Sakao, K. Ishida, K. Tatsumi
{"title":"Efficacy and safety of inferior vena cava filters in patients with surgically treated chronic thromboembolic pulmonary hypertension","authors":"Akane Sasaki, Rika Suda, N. Tanabe, Ryogo Ema, Keiko Yamamoto, H. Miwa, A. Naito, H. Kasai, T. Jujo, T. Sugiura, Naoko Kawata, S. Sakao, K. Ishida, K. Tatsumi","doi":"10.1183/13993003.congress-2019.pa1463","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1463","url":null,"abstract":"","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90573510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1461
Harshil Alwani, A. Mohapatra, Saswat Subhankar, D. P. Dash
{"title":"Unusual Presentation of a Systemic Disease: A Case Report","authors":"Harshil Alwani, A. Mohapatra, Saswat Subhankar, D. P. Dash","doi":"10.1183/13993003.congress-2019.pa1461","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1461","url":null,"abstract":"","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78730449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3645
Y. Freund, A. Philippon, A. Feral-Pierssens, Clara Damas Perrichet, S. Boussouar, V. Donciu, M. Cachanado, Pierre-Alexis Raynal
Introduction: The prevalence of pulmonary embolism (PE) in patients that present to the Emergency Department (ED) with isolated syncope is unclear. Conflicting results were recently reported with a prevalence ranging from less than 1% to up to 17%. However, these studies included patients that may also have had other symptoms suggestive of PE (chest pain or dyspnea), or patients that had no systematic assessment for the presence of PE. Since a low prevalence ( Aims: to evaluate the prevalence of PE in ED patients with isolated syncope. Methods: Multicenter prospective cohort study in seven EDs in France. Adult patients who presented to the ED with syncope (transient loss of consciousness) were included. Patients with chest pain or dyspnea were excluded. Included patients underwent formal work-up for PE, including D-dimer testing and further imaging if positive. Cases of PE were adjudicated by two independent expert radiologists with the review of imaging studies. Results: 411 patients were recruited and tested with D-dimer, in whom 137 (33%) underwent a computed tomographic pulmonary angiogram or a ventilation-perfusion scan. A PE was confirmed in nine patients (prevalence of 2.2%, 95% confidence interval 1.1% to 4.3%), including one sub-segmental PE. Conclusion: In our sample of patients with isolated syncope, the prevalence of PE was 2.2%. This value is not sufficiently low to negate the requirement for a formal work up in the ED, even in the absence of chest pain or dyspnea.
{"title":"Prevalence of pulmonary embolism in patients with isolated syncope in the emergency department: the PEEPS multicenter prospective cohort study","authors":"Y. Freund, A. Philippon, A. Feral-Pierssens, Clara Damas Perrichet, S. Boussouar, V. Donciu, M. Cachanado, Pierre-Alexis Raynal","doi":"10.1183/13993003.congress-2019.pa3645","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3645","url":null,"abstract":"Introduction: The prevalence of pulmonary embolism (PE) in patients that present to the Emergency Department (ED) with isolated syncope is unclear. Conflicting results were recently reported with a prevalence ranging from less than 1% to up to 17%. However, these studies included patients that may also have had other symptoms suggestive of PE (chest pain or dyspnea), or patients that had no systematic assessment for the presence of PE. Since a low prevalence ( Aims: to evaluate the prevalence of PE in ED patients with isolated syncope. Methods: Multicenter prospective cohort study in seven EDs in France. Adult patients who presented to the ED with syncope (transient loss of consciousness) were included. Patients with chest pain or dyspnea were excluded. Included patients underwent formal work-up for PE, including D-dimer testing and further imaging if positive. Cases of PE were adjudicated by two independent expert radiologists with the review of imaging studies. Results: 411 patients were recruited and tested with D-dimer, in whom 137 (33%) underwent a computed tomographic pulmonary angiogram or a ventilation-perfusion scan. A PE was confirmed in nine patients (prevalence of 2.2%, 95% confidence interval 1.1% to 4.3%), including one sub-segmental PE. Conclusion: In our sample of patients with isolated syncope, the prevalence of PE was 2.2%. This value is not sufficiently low to negate the requirement for a formal work up in the ED, even in the absence of chest pain or dyspnea.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73711782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1454
B. Vijayakumar, C. Davies, M. Gibson
{"title":"Outpatient management of PE","authors":"B. Vijayakumar, C. Davies, M. Gibson","doi":"10.1183/13993003.congress-2019.pa1454","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1454","url":null,"abstract":"","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73761542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1464
Li Zhu
{"title":"A preliminary study on CT quantitative evaluation of small pulmonary vessels area in patients with acute pulmonary embolism","authors":"Li Zhu","doi":"10.1183/13993003.congress-2019.pa1464","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1464","url":null,"abstract":"","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88694603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1457
W. Thomas, E. Symington, M. Besser, K. Sheares
2 trials report effective secondary prevention with low dose apixaban or rivaroxaban after the initial treatment period for VTE (Agnelli 2013 & Weitz 2017). This is a retrospective service evaluation of low dose DOAC over 1 year in patients with unprovoked VTE. Methods: At 3 months post PE or proximal DVT, patients are assessed for VTE and bleeding risk factors. Patients with unprovoked VTE (without chronic thromboembolic pulmonary hypertension, high risk inherited thrombophilia or antiphospholipid syndrome & Results: 212 patients continued DOAC as extended thromboprophylaxis; 79 (37%) with standard dose and 133 (63%) with low dose. Of the patients that continued with low dose DOAC, there was 1 VTE recurrence in 137.4 patient years follow-up; a recurrence rate of 0.7/100 patient years (95% CI 0.0 – 4.0). There were no major bleeds or deaths (95% CI 0.0 – 2.7/100 patient years). Conclusion: At our centre, 63% of patients are treated with low dose DOAC and an average follow-up of more than a year showed low VTE recurrence and major bleeding rates. Larger trials are awaited
2项试验报告了VTE初始治疗期后低剂量阿哌沙班或利伐沙班的有效二级预防(Agnelli 2013 & Weitz 2017)。这是一项低剂量DOAC治疗非诱发性静脉血栓栓塞患者超过1年的回顾性服务评估。方法:在肺动脉栓塞或近端DVT后3个月，对患者进行静脉血栓栓塞和出血危险因素评估。非诱发性静脉血栓栓塞患者(无慢性血栓栓塞性肺动脉高压、高风险遗传性血栓形成或抗磷脂综合征)&结果:212例患者继续DOAC作为延长血栓预防;标准剂量79例(37%)，低剂量133例(63%)。在继续使用低剂量DOAC的患者中，在137.4患者年的随访中有1例静脉血栓栓塞复发;复发率为0.7/100患者年(95% CI 0.0 - 4.0)。无大出血或死亡(95% CI 0.0 - 2.7/100患者年)。结论:在本中心，63%的患者接受了低剂量DOAC治疗，平均随访一年以上，静脉血栓栓塞复发和大出血率较低。更大规模的试验正在等待中
{"title":"A single centre experience of low dose direct oral anticoagulants (DOAC) after unprovoked venous thromboembolism (VTE)","authors":"W. Thomas, E. Symington, M. Besser, K. Sheares","doi":"10.1183/13993003.congress-2019.pa1457","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1457","url":null,"abstract":"2 trials report effective secondary prevention with low dose apixaban or rivaroxaban after the initial treatment period for VTE (Agnelli 2013 & Weitz 2017). This is a retrospective service evaluation of low dose DOAC over 1 year in patients with unprovoked VTE. Methods: At 3 months post PE or proximal DVT, patients are assessed for VTE and bleeding risk factors. Patients with unprovoked VTE (without chronic thromboembolic pulmonary hypertension, high risk inherited thrombophilia or antiphospholipid syndrome & Results: 212 patients continued DOAC as extended thromboprophylaxis; 79 (37%) with standard dose and 133 (63%) with low dose. Of the patients that continued with low dose DOAC, there was 1 VTE recurrence in 137.4 patient years follow-up; a recurrence rate of 0.7/100 patient years (95% CI 0.0 – 4.0). There were no major bleeds or deaths (95% CI 0.0 – 2.7/100 patient years). Conclusion: At our centre, 63% of patients are treated with low dose DOAC and an average follow-up of more than a year showed low VTE recurrence and major bleeding rates. Larger trials are awaited","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90908082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3649
P. Intiglietta, Maria Peragine, P. Buonamico, G. Castellana, O. Resta
Introduction: Pulmonary embolism (PE) is described in 25% of Chronic Obstructive Pulmonary Disease (COPD) hospitalized patients and may simulate or worsen an episode of acute exacerbation. It should be taken into account in COPD patients with clinical worsening. Aim: To assess whether COPD may be an independent risk factor for PE. Methods: We investigated 91 patients (M:F=1:2, mean age of 69 years) hospitalized for PE at our department from January 2014 to February 2016 and divided them in two groups according to the presence of COPD defined according to GOLD guideline: Group1, PE with COPD (54 patients); Group2, PE without COPD (37 patients). We searched the presence of deep vein thrombosis (DVT), with compression ultrasound sonography plus eco-color doppler, and PE risk factors in all patients. Statistical significance: p ≤0.05. Results: Group1 had less prevalence of DVT (49% vs 66%), next the significance (p=0,09), and of male sex (p=0,009), higher prevalence of smokers (p=0,000), proximal PE (0,04), mean age (p=0,03), paO2 and paCO2 (0,0003) and diabetes than Group2 (p=0,000). No difference was documented in risk factor of PE, i.e. obesity, cancer, atrial fibrillation, liver disease, bed rest and contraceptives. Limiting the analysis to proximal PE, the difference of prevalence of DVT increases (33% Group1 vs. 70% Group2) and becomes significant (p = 0,04). COPD patients without DVT (37) had higher age, lower PaCO2, minor increase in Ddimers, the lower FE, lower prevalence of renal failure (p Conclusion: COPD may be an indipendent risk factor for PE, in particular with proximal location. Absence of DVT is more frequent than in patient without COPD.
{"title":"COPD is an indipendent risk factor for in-situ pulmonary artery thrombosis","authors":"P. Intiglietta, Maria Peragine, P. Buonamico, G. Castellana, O. Resta","doi":"10.1183/13993003.congress-2019.pa3649","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3649","url":null,"abstract":"Introduction: Pulmonary embolism (PE) is described in 25% of Chronic Obstructive Pulmonary Disease (COPD) hospitalized patients and may simulate or worsen an episode of acute exacerbation. It should be taken into account in COPD patients with clinical worsening. Aim: To assess whether COPD may be an independent risk factor for PE. Methods: We investigated 91 patients (M:F=1:2, mean age of 69 years) hospitalized for PE at our department from January 2014 to February 2016 and divided them in two groups according to the presence of COPD defined according to GOLD guideline: Group1, PE with COPD (54 patients); Group2, PE without COPD (37 patients). We searched the presence of deep vein thrombosis (DVT), with compression ultrasound sonography plus eco-color doppler, and PE risk factors in all patients. Statistical significance: p ≤0.05. Results: Group1 had less prevalence of DVT (49% vs 66%), next the significance (p=0,09), and of male sex (p=0,009), higher prevalence of smokers (p=0,000), proximal PE (0,04), mean age (p=0,03), paO2 and paCO2 (0,0003) and diabetes than Group2 (p=0,000). No difference was documented in risk factor of PE, i.e. obesity, cancer, atrial fibrillation, liver disease, bed rest and contraceptives. Limiting the analysis to proximal PE, the difference of prevalence of DVT increases (33% Group1 vs. 70% Group2) and becomes significant (p = 0,04). COPD patients without DVT (37) had higher age, lower PaCO2, minor increase in Ddimers, the lower FE, lower prevalence of renal failure (p Conclusion: COPD may be an indipendent risk factor for PE, in particular with proximal location. Absence of DVT is more frequent than in patient without COPD.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83843056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3638
T. Lim, J. Zhang, Y. G. Goh
A low test threshold for pulmonary embolism(PE) and over reliance on imaging, especially CT pulmonary angiograms(CTPA) is a common behaviour pattern among physicians. Interventions to improve this low threshold for CTPA testing have been mostly ineffective. The innovative Dutch YEARS study reported fewer CTPA examinations in PE diagnosis(van der Hulle et al. Lancet 2017;390:289). However, the YEARS algorithm have not been evaluated in routine clinical practice. Thus, we examined the effects of implementing a pragmatic, modified version of the YEARS algorithm in PE diagnosis. Methods: This is a prospective study of consecutive hospitalized adult patients who underwent CTPA for PE in an acute medicine department. In 2016 we initiated an audit-feedback program to improve the adherence to evidence based guidelines for PE diagnosis and thus, increase the diagnostic rate of PE from CTPA. In 2018 we implemented a modified YEARS protocol. Results: In 2016 the PE detection rate from CTPA was 7.8%. This was associated with more frequent assessment of pre-test risks and D-dimer testing but an insignificant increase in PE diagnosis from CTPA compared with 2015(7%). In 2018, following the introduction of the modified YEARS protocol, this PE diagnosis rate increased to 25%(p Conclusions: Physician education and real-time feedback had a small effect in improving adherence to PE diagnostic protocols and reducing CTPA testing. Implementation of the YEARS protocol resulted in further improvements and merits more extensive evaluation in secular practice.
肺栓塞(PE)的低检测阈值和过度依赖影像学，特别是CT肺血管造影(CTPA)是医生常见的行为模式。改善CTPA检测低门槛的干预措施大多无效。创新的荷兰YEARS研究报告CTPA检查在PE诊断中较少(van der Hulle等)。《柳叶刀》2017年;390:289)。然而，YEARS算法尚未在常规临床实践中进行评估。因此，我们研究了在PE诊断中实施实用的改进版YEARS算法的效果。方法:这是一项前瞻性研究，连续住院的成人患者在急诊科接受CTPA治疗PE。2016年，我们启动了一项审计反馈计划，以提高对基于证据的PE诊断指南的依从性，从而提高CTPA对PE的诊断率。2018年，我们实施了修改后的YEARS协议。结果:2016年CTPA的PE检出率为7.8%。这与更频繁的检测前风险评估和d -二聚体检测相关，但与2015年相比，CTPA的PE诊断增加不显著(7%)。2018年，在引入修改后的YEARS方案后，PE诊断率增加到25%(p)。结论:医生教育和实时反馈在提高PE诊断方案的依从性和减少CTPA检测方面效果不大。YEARS协议的实施带来了进一步的改进，值得在长期实践中进行更广泛的评估。
{"title":"The impact of implementing a modified YEARS algorithm on the diagnosis of pulmonary embolism","authors":"T. Lim, J. Zhang, Y. G. Goh","doi":"10.1183/13993003.congress-2019.pa3638","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3638","url":null,"abstract":"A low test threshold for pulmonary embolism(PE) and over reliance on imaging, especially CT pulmonary angiograms(CTPA) is a common behaviour pattern among physicians. Interventions to improve this low threshold for CTPA testing have been mostly ineffective. The innovative Dutch YEARS study reported fewer CTPA examinations in PE diagnosis(van der Hulle et al. Lancet 2017;390:289). However, the YEARS algorithm have not been evaluated in routine clinical practice. Thus, we examined the effects of implementing a pragmatic, modified version of the YEARS algorithm in PE diagnosis. Methods: This is a prospective study of consecutive hospitalized adult patients who underwent CTPA for PE in an acute medicine department. In 2016 we initiated an audit-feedback program to improve the adherence to evidence based guidelines for PE diagnosis and thus, increase the diagnostic rate of PE from CTPA. In 2018 we implemented a modified YEARS protocol. Results: In 2016 the PE detection rate from CTPA was 7.8%. This was associated with more frequent assessment of pre-test risks and D-dimer testing but an insignificant increase in PE diagnosis from CTPA compared with 2015(7%). In 2018, following the introduction of the modified YEARS protocol, this PE diagnosis rate increased to 25%(p Conclusions: Physician education and real-time feedback had a small effect in improving adherence to PE diagnostic protocols and reducing CTPA testing. Implementation of the YEARS protocol resulted in further improvements and merits more extensive evaluation in secular practice.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83885499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa1459
Christiane Meyer-Aumiller, J. Aumiller
{"title":"Pulmonary Embolism (PE) in women with hormonal contraception (WHC) primarily diagnosed via endobronchial ultrasound angiography (EBUS-A)","authors":"Christiane Meyer-Aumiller, J. Aumiller","doi":"10.1183/13993003.congress-2019.pa1459","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa1459","url":null,"abstract":"","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90569613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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