The diagnostic pathway embolism: from the Emergency Department to the Internal Medicine Unit
| Autor: | Mauro Silingardi, Attilia Maria Pizzini, Annamaria Ferrari, Stefano De Pietri, Ido Iori, Maria Cristina Leone, Daniela Galimberti |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Deep vein lcsh:Medicine Signs and symptoms 030204 cardiovascular system & hematology clinical pre-test-probability 03 medical and health sciences 0302 clinical medicine Medicine 030212 general & internal medicine Intensive care medicine computerized decision support system business.industry Pulmonary embolism pulmonary computed tomography lcsh:R General Medicine Emergency department medicine.disease Thrombosis medicine.anatomical_structure Embolism Presentation (obstetrics) business Sudden onset |
| Zdroj: | Italian Journal of Medicine, Vol 10, Iss 1, Pp 4-9 (2016) |
| ISSN: | 1877-9352 1877-9344 |
| Popis: | The diagnostic pathway of pulmonary embolism, both in the Emergency Department and in the Medical Unit, is not a standardized one. Pulmonary embolism, often but not always complicating surgery, malignancies, different medical diseases, sometimes but not often associated with a deep vein thrombosis, is not infrequently a sudden onset life-threatening and rapidly fatal clinical condition. Most of the deaths due to pulmonary embolism occur at presentation or during the first days after admission; it is therefore of vital importance that pulmonary embolism should promptly be diagnosed and treated in order to avoid unexpected deaths; a correct risk stratification should also be made for choosing the most appropriate therapeutic options. We review the tools we dispose of for a correct clinical assessment, the existing risk scores, the advantages and limits of available diagnostic instruments. As for clinical presentation we remind the great variability of pulmonary embolism signs and symptoms and underline the importance of obtaining clinical probability scores before making requests for further diagnostic tests, in particular for pulmonary computer tomography; the Wells score is the only in-hospital validated one, but unfortunately is still largely underused. We describe our experience in two different periods of time and clinical settings in the initial evaluation of a suspected pulmonary embolism; in the first one we availed ourselves of a computerized support based on Wells score, in the second one we did not. Analysing the results we obtained in terms of diagnostic yield in these two periods, we observed that the computerized support system significantly improved our pulmonary embolism diagnostic accuracy. |
| Databáze: | OpenAIRE |
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