Prevalence of Pulmonary Embolism Among Emergency Department Patients With Syncope: A Multicenter Prospective Cohort Study
| Autor: | Aveh Bastani, Marco L.A. Sivilotti, Longlong Huang, Christopher W. Baugh, Brian H. Rowe, Marie-Joe Nemnom, Sarah Gaudet, Alan B. Storrow, Susan Malveau, Daniel K. Nishijima, Manish N. Shah, Bret A. Nicks, Jeffrey M. Caterino, Scott T. Wilber, Muhammad Mukarram, Soo-Min Kim, Andrew D McRae, Annick N. Yagapen, Kirk A. Stiffler, David H. Adler, Judd E. Hollander, Benjamin C. Sun, Monica Taljaard, Carol L. Clark, Venkatesh Thiruganasambandamoorthy, Deborah B. Diercks |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Canada Pediatrics medicine.medical_specialty Syncope 03 medical and health sciences 0302 clinical medicine Prevalence Pulmonary angiography Humans Medicine Prospective Studies 030212 general & internal medicine Myocardial infarction Prospective cohort study Aged biology business.industry Syncope (genus) 030208 emergency & critical care medicine Emergency department Middle Aged medicine.disease biology.organism_classification United States 3. Good health Pulmonary embolism Embolism Concomitant Emergency Medicine Female Emergency Service Hospital Pulmonary Embolism business |
| Zdroj: | Annals of Emergency Medicine. 73:500-510 |
| ISSN: | 0196-0644 |
| DOI: | 10.1016/j.annemergmed.2018.12.005 |
| Popis: | Study objective The prevalence of pulmonary embolism among patients with syncope is understudied. In accordance with a recent study with an exceptionally high pulmonary embolism prevalence, some advocate evaluating all syncope patients for pulmonary embolism, including those with another clear cause for their syncope. We seek to evaluate the pulmonary embolism prevalence among emergency department (ED) patients with syncope. Methods We combined data from 2 large prospective studies enrolling adults with syncope from 17 EDs in Canada and the United States. Each study collected the results of pulmonary embolism–related investigations (ie, D-dimer, ventilation-perfusion scan, or computed tomography [CT] pulmonary angiography) and 30-day adjudicated outcomes: pulmonary embolism or nonpulmonary embolism outcome (arrhythmia, myocardial infarction, serious hemorrhage, and death). Results Of the 9,374 patients enrolled, 9,091 (97.0%; median age 66 years, 51.9% women) with 30-day follow-up were analyzed: 547 (6.0%) were evaluated for pulmonary embolism (278 [3.1%] had D-dimer, 39 [0.4%] had ventilation-perfusion scan, and 347 [3.8%] had CT pulmonary angiography). Overall, 874 patients (9.6%) experienced 30-day serious outcomes: 818 patients (9.0%) with nonpulmonary embolism serious outcomes and 56 (prevalence 0.6%; 95% confidence interval 0.5% to 0.8%) with pulmonary embolism (including 8 [0.2%] out of 3521 patients diagnosed during the index hospitalization and 7 [0.1%] diagnosed after the index visit). Eighty-six patients (0.9%) died, and 4 deaths (0.04%) were related to pulmonary embolism. Only 11 patients (0.1%) with a nonpulmonary embolism serious condition had a concomitant pulmonary embolism. Conclusion The prevalence of pulmonary embolism is very low among ED patients with syncope, including those hospitalized after syncope. Although an underlying pulmonary embolism may cause syncope, clinicians should be cautious about indiscriminate investigations for pulmonary embolism. |
| Databáze: | OpenAIRE |
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