Ambulatory vital signs in the workup of pulmonary embolism using a standardized 3-minute walk test
| Autor: | Subhra Mohapatra, Marc A. Rodger, Ian G. Stiell, Jeffrey J. Perry, Abdulaziz Alsadoon, Qamar Amin |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Walking Internal medicine Heart rate Outpatients medicine Humans Prospective Studies Prospective cohort study Oxygen saturation (medicine) Aged business.industry Emergency department Middle Aged medicine.disease Thrombosis Confidence interval Pulmonary embolism Respiratory Function Tests Ambulatory Emergency Medicine Physical therapy Cardiology Exercise Test Female business Emergency Service Hospital Pulmonary Embolism Follow-Up Studies |
| Zdroj: | CJEM. 17(3) |
| ISSN: | 1481-8043 1481-8035 |
| Popis: | ObjectiveDiagnosing pulmonary embolism can be difficult given its highly variable clinical presentation. Our objective was to determine whether a decrease in oxygen saturation or an increase in heart rate while ambulating could be used as an objective tool in the diagnosis of pulmonary embolism.MethodsThis was a two-site tertiary-care-centre prospective cohort study that enrolled adult emergency department or thrombosis clinic patients with suspected or newly confirmed pulmonary embolism. Patients were asked to participate in a standardized 3-minute walk test, which assessed ambulatory heart rate and ambulatory oxygen saturation. The primary outcome was pulmonary embolism.ResultsWe enrolled 114 patients, including 30 with pulmonary embolism (26.3%). A ≥2% absolute decrease in ambulatory oxygen saturation and an ambulatory change in heart rate >10 beats per minute (BPM) were significantly associated with pulmonary embolism. An ambulatory heart rate change of >10 BPM had a sensitivity of 96.6% (95% confidence interval [CI] 83.3 to 99.4) and a specificity of 31.0% (95% CI 22.1 to 45.0) for pulmonary embolism. A ≥2% absolute decrease ambulatory oxygen saturation had a sensitivity of 80.2% (95% CI 62.7 to 90.5) and a specificity of 39.3% (95% CI 29.5 to 50.0) for pulmonary embolism. The combination of both variables yielded a sensitivity of 100.0% (95% CI 87.0 to 100.0) and a specificity of 11.0% (95% CI 6.6 to 21.0).ConclusionIn summary, our study found that an ambulatory heart rate change of >10 BPM or a ≥2% absolute decrease in ambulatory oxygen saturation from baseline during a standardized 3-minute walk test are highly correlated with pulmonary embolism. Although the findings appear promising, neither of these variables can currently be recommended as a screening tool for pulmonary embolism until larger prospective studies examine their performance either alone or with pre-existing rules. |
| Databáze: | OpenAIRE |
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