Prevalence of Pulmonary Embolism in Patients With Syncope.

Adult Aged Aged, 80 and over Emergency Service, Hospital / statistics & numerical data Female Global Health Humans Incidence Male Middle Aged Prevalence Prognosis Prospective Studies Pulmonary Embolism / epidemiology Risk Factors Survival Rate / trends Syncope / complications
diagnostic testing pulmonary embolism syncope

Journal

Journal of the American College of Cardiology
ISSN: 1558-3597
Titre abrégé: J Am Coll Cardiol
Pays: United States
ID NLM: 8301365

Informations de publication

Date de publication:
13 08 2019
Historique:
received: 05 02 2019
revised: 19 05 2019
accepted: 03 06 2019
entrez: 10 8 2019
pubmed: 10 8 2019
medline: 15 5 2020
Statut: ppublish

Résumé

The prevalence of pulmonary embolism (PE) in patients presenting with syncope to the emergency department (ED) is largely unknown. This information, however, is necessary to balance the potential medical benefit or harm of systematic PE screening in patients presenting with syncope to the ED. This study sought to determine the prevalence of PE in patients with syncope. Unselected patients presenting with syncope to the ED were prospectively enrolled in a diagnostic multicenter study. Pre-test clinical probability for PE was assessed using the 2-level Wells score and the results of D-dimer testing using age-adapted cutoffs. Presence of PE was evaluated by imaging modalities, when ordered as part of the clinical assessment by the treating ED physician or by long-term follow-up data. Long-term follow-up was complete in 1,380 patients (99%) at 360 days and 1,156 patients (83%) at 720 days. Among 1,397 patients presenting with syncope to the ED, PE was detected at presentation in 19 patients (1.4%; 95% confidence interval [CI]: 0.87% to 2.11%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.5% to 1.5%). In the subgroup of patients hospitalized (47%), PE was detected at presentation in 15 patients (2.3%; 95% CI: 1.4% to 3.7%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.4% to 2.0%). PE seems to be a rather uncommon cause of syncope among patients presenting to the ED. Therefore, systematic PE-screening in all patients with syncope does not seem warranted. (BAsel Syncope EvaLuation Study [BASEL IX]; NCT01548352).

Sections du résumé

BACKGROUND
The prevalence of pulmonary embolism (PE) in patients presenting with syncope to the emergency department (ED) is largely unknown. This information, however, is necessary to balance the potential medical benefit or harm of systematic PE screening in patients presenting with syncope to the ED.
OBJECTIVES
This study sought to determine the prevalence of PE in patients with syncope.
METHODS
Unselected patients presenting with syncope to the ED were prospectively enrolled in a diagnostic multicenter study. Pre-test clinical probability for PE was assessed using the 2-level Wells score and the results of D-dimer testing using age-adapted cutoffs. Presence of PE was evaluated by imaging modalities, when ordered as part of the clinical assessment by the treating ED physician or by long-term follow-up data.
RESULTS
Long-term follow-up was complete in 1,380 patients (99%) at 360 days and 1,156 patients (83%) at 720 days. Among 1,397 patients presenting with syncope to the ED, PE was detected at presentation in 19 patients (1.4%; 95% confidence interval [CI]: 0.87% to 2.11%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.5% to 1.5%). In the subgroup of patients hospitalized (47%), PE was detected at presentation in 15 patients (2.3%; 95% CI: 1.4% to 3.7%). The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9% (95% CI: 0.4% to 2.0%).
CONCLUSIONS
PE seems to be a rather uncommon cause of syncope among patients presenting to the ED. Therefore, systematic PE-screening in all patients with syncope does not seem warranted. (BAsel Syncope EvaLuation Study [BASEL IX]; NCT01548352).

Identifiants

DOI: 10.1016/j.jacc.2019.06.020 PMID: 31395124
pubmed: 31395124
pii: S0735-1097(19)35610-4
doi: 10.1016/j.jacc.2019.06.020
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT01548352']

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

744-754

Investigateurs

Maria Rubini Giménez (M)
Nikola Kozhuharov (N)
Samyut Shrestha (S)
Lorraine Sazgary (L)
Beata Morawiec (B)
Piotr Muzyk (P)
Ewa Nowalany-Kozielska (E)
José Bustamante Mandrión (J)
Imke Poepping (I)
Michael Freese (M)
Kathrin Meissner (K)
Caroline Kulangara (C)
Carolina Isabel Fuenzalida Inostroza (CI)
Jaimi Greenslade (J)
Tracey Hawkins (T)
Katharina Rentsch (K)
Arnold von Eckardstein (A)
Andreas Buser (A)
Wanda Kloos (W)
Jana Steude (J)
Stefan Osswald (S)

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2019. Published by Elsevier Inc.

Auteurs

Patrick Badertscher (P)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois. Electronic address: https://twitter.com/BadertscherPat.

Jeanne du Fay de Lavallaz (J)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy. Electronic address: https://twitter.com/JDFDLz.

Angelika Hammerer-Lercher (A)

Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland.

Thomas Nestelberger (T)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.

Tobias Zimmermann (T)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.

Marc Geiger (M)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.

Orell Imahorn (O)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.

Òscar Miró (Ò)

GREAT network, Rome, Italy; Hospital Clinic, Barcelona, Catalonia, Spain.

Emilio Salgado (E)

GREAT network, Rome, Italy; Hospital Clinic, Barcelona, Catalonia, Spain.

Michael Christ (M)

General Hospital, Paracelsus Medical University, Nürnberg, Germany.

Louise Cullen (L)

GREAT network, Rome, Italy; Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.

Martin Than (M)

GREAT network, Rome, Italy; Christchurch Hospital, Christchurch, New Zealand.

F Javier Martin-Sanchez (FJ)

GREAT network, Rome, Italy; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.

Salvatore Di Somma (S)

GREAT network, Rome, Italy; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy.

W Frank Peacock (WF)

GREAT network, Rome, Italy; Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.

Dagmar I Keller (DI)

University Hospital Zürich, Zürich, Switzerland.

Juan Pablo Costabel (JP)

Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.

Joan Walter (J)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.

Jasper Boeddinghaus (J)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.

Raphael Twerenbold (R)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.

Adriana Méndez (A)

Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland.

Boris Gospodinov (B)

Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland.

Christian Puelacher (C)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.

Desiree Wussler (D)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.

Luca Koechlin (L)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.

Damian Kawecki (D)

GREAT network, Rome, Italy; 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.

Nicolas Geigy (N)

Emergency Department, Kantonsspital Liestal, Liestal, Switzerland.

Ivo Strebel (I)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy.

Jens Lohrmann (J)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.

Michael Kühne (M)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.

Tobias Reichlin (T)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiology, Inselspital Bern, Bern, Switzerland.

Christian Mueller (C)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy. Electronic address: christian.mueller@usb.ch.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Caractéristiques de la population › Santé › Santé mondiale › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Incidence › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Prévalence › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Diagnostic › Pronostic › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Embolie › Embolie pulmonaire › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Taux de survie › Prevalence of Pulmonary Embolism in Patients...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Perte de conscience › Syncope › Prevalence of Pulmonary Embolism in Patients...