Pulmonary embolism prevalence among emergency department cohorts: A systematic review and meta-analysis by country of study.
diagnosis
multidetector computed tomography
prevalence
pulmonary embolism
systematic review
venous thromboembolism
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
08
08
2020
revised:
08
09
2020
accepted:
28
09
2020
pubmed:
14
10
2020
medline:
15
5
2021
entrez:
13
10
2020
Statut:
ppublish
Résumé
Essentials The threshold to test for pulmonary embolism (PE) might be lower in North America than Europe. We compared the PE prevalence and positive yield of imaging in Europe and North America. More patients tested in Europe are diagnosed with PE, and imaging is more often positive. Our systematic review supports the hypothesis of overtesting for PE in North America. ABSTRACT: Background There is an impression that North American emergency department (ED) patients tested for pulmonary embolism (PE) differ from European ones. Objectives We compared the PE prevalence, frequency of use, and positive yield of imaging among ED patients tested for PE in Europe and North America. Methods We searched for studies reporting consecutive ED patients tested for PE. Two authors screened full texts, performed risk of bias assessment, and data extraction. We conducted a meta-analysis of proportions for each outcome and a multiple meta-regression. Results From 3109 publications, 44 were included in the systematic review. The prevalence of PE in Europe was 23% (95% confidence interval [CI], 21-26) and in North America 8% (95% CI, 6-9). The adjusted mean difference (aMD) in the prevalence of PE in the European compared with North American studies, was 15% (95% CI, 10-20). Computed tomography pulmonary angiography (CTPA) was used in 60% (95% CI, 52%-68) of European and 38% (95% CI, 24-51) of North American patients tested for PE (aMD, 23% [95% CI, 7-39]). The CTPA diagnostic yield was 29% (95% CI, 26-32) in Europe and 13% (95% CI, 9-17) in North America (aMD, 15% [95% CI, 8-21]). Conclusion Compared with North America, European ED studies have a higher prevalence of PE and diagnostic yield from CTPA, despite a higher frequency of CTPA use among patients tested for PE. This supports the hypothesis that those tested for PE in North American EDs have a lower risk of PE compared with Europe.
Identifiants
pubmed: 33048461
doi: 10.1111/jth.15124
pii: S1538-7836(22)00435-4
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
173-185Informations de copyright
© 2020 International Society on Thrombosis and Haemostasis.
Références
Raskob GE, Angchaisuksiri P, Blanco AN, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34(11):2363-2371. https://doi.org/10.1161/ATVBAHA.114.304488
Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med. 2011;171(9):831-837. https://doi.org/10.1001/archinternmed.2011.178
Pernod G, Caterino J, Maignan M, Tissier C, Kassis J, Lazarchick J. D-dimer use and pulmonary embolism diagnosis in emergency units: why is there such a difference in pulmonary embolism prevalence between the United States of America and countries outside USA? PLoS One. 2017;12(1):1-11. https://doi.org/10.1371/journal.pone.0169268
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008-2012.
Beller EM, Glasziou PP, Altman DG, et al. PRISMA for abstracts: reporting systematic reviews in journal and conference abstracts. PLoS Med. 2013;10(4):e1001419. https://doi.org/10.1371/journal.pmed.1001419
Hogg K, Eventov M, Turcotte M, Rigg K, Li M.The incidence of pulmonary embolism in emergency department patients, reported by country of study: a systematic review. PROSPERO International prospective register of systematic reviews. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42015025447. Published 2015. Accessed August 10, 2018.
CLARITY Group. Tool to assess risk of bias in longitudinal symptom research studies aimed at the general population. https://www.evidencepartners.com/wp-content/uploads/2017/09/Tool-to-Assess-Risk-of-Bias-Longitudinal-Symptom-Research-Studies-Aimed-at-the-General-Population.pdf. Accessed April 5, 2019.
Rücker G, Schwarzer G, Carpenter J, Olkin I. Why add anything to nothing? The arcsine difference as a measure of treatment effect in meta-analysis with zero cells. Stat Med. 2009;28(5):721-738. https://doi.org/10.1002/sim.3511
Bounameaux H, Cirafici P, Demoerloose P, et al. Measurement of D-dimer in plasma as diagnostic-aid in suspected pulmonary-embolism. Lancet. 1991;337(8735):196-200. https://doi.org/10.1016/0140-6736(91)92158-X
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. https://doi.org/10.1186/s13643-016-0384-4
Hunter JP, Saratzis A, Sutton AJ, Boucher RH, Sayers RD, Bown MJ. In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol. 2014;67(8):897-903. https://doi.org/10.1016/j.jclinepi.2014.03.003
Public Health England - technical guidance. https://fingertips.phe.org.uk/profile/guidance. Accessed April 10, 2019
Acar H, Yılmaz S, Yaka E, Doğan NÖ, Özbek AE, Pekdemir M. Evaluation of the diagnostic role of bedside lung ultrasonography in patients with suspected pulmonary embolism in the emergency department. Balkan Med J. 2017;34(4):356-361. https://doi.org/10.4274/balkanmedj.2016.1181
Anderson DR, Kovacs MJ, Dennie C, et al. Use of spiral computed tomography contrast angiography and ultrasonography to exclude the diagnosis of pulmonary embolism in the Emergency Department. J Emerg Med. 2005;29(4):399-404. https://doi.org/10.1016/j.jemermed.2005.05.010
Harenberg J, Goldammer L, Marx S, Weiss C. Improvement of the positive predictive value of a combination of D-dimer with concomitant diseases for diagnosis of deep vein thrombosis and pulmonary embolism. Pathophysiol Haemost Thromb. 2010;37:A44.
Hogg K, Hinchliffe E, Haslam S, Sethi B, Carrier M, Lecky F. Predicting short term mortality after investigation for venous thromboembolism. Thromb Res. 2013;131(4):e141-e146. https://doi.org/10.1016/j.thromres.2013.01.030
Jimenez D, Resano S, Otero R, et al. Computerised clinical decision support for suspected PE. Thorax. 2015;70(9):909-911.
Kabrhel C, McAfee AT, Goldhaber SZ. The contribution of the subjective component of the Canadian Pulmonary Embolism Score to the overall score in emergency department patients. Acad Emerg Med. 2005;12(10):915-920.
Kabrhel C, Matts C, McNamara M, Katz J, Ptak T. A highly sensitive ELISA D-dimer increases testing but not diagnosis of pulmonary embolism. Acad Emerg Med. 2006;13(5):519-524.
Kline JA, Webb WB, Jones AE, Hernandez-Nino J. Impact of a rapid rule-out protocol for pulmonary embolism on the rate of screening, missed cases, and pulmonary vascular imaging in an urban US emergency department. Ann Emerg Med. 2004;44(5):490-502. https://doi.org/10.1016/S0196064404002872
Kline JA, Hogg M. Measurement of expired carbon dioxide, oxygen and volume in conjunction with pretest probability estimation as a method to diagnose and exclude pulmonary venous thromboembolism. Clin Physiol Funct Imaging. 2006;26(4):212-219.
Kline JA, Runyon MS, Webb WB, Jones AE, Mitchell AM. Prospective study of the diagnostic accuracy of the simplify D-dimer assay for pulmonary embolism in emergency department patients. Chest. 2006;129(6):1417-1423. https://doi.org/10.1378/chest.129.6.1417
Mansencal N, Vieillard-Baron A, Beauchet A, et al. Triage patients with suspected pulmonary embolism in the emergency department using a portable ultrasound device. Echocardiography. 2008;25(5):451-456. https://doi.org/10.1111/j.1540-8175.2007.00623.x
Nazerian P, Volpicelli G, Gigli C, et al. Diagnostic performance of wells score combined with point-of-care lung and venous ultrasound in suspected pulmonary embolism. Acad Emerg Med. 2017;24(3):270-280. https://doi.org/10.1111/acem.13130
Ng BJH, Lindstrom S. Study of compliance with a clinical pathway for suspected pulmonary embolism. Intern Med J. 2011;41(3):251-257.
Penaloza A, Melot C, Dochy E, et al. Assessment of pretest probability of pulmonary embolism in the emergency department by physicians in training using the Wells model. Thromb Res. 2007;120(2):173-179. https://doi.org/10.1016/j.thromres.2006.09.001
Perrier A, Desmarais S, Goehring C, et al. D-dimer testing for suspected pulmonary embolism in outpatients. Am J Respir Crit Care Med. 1997;156(2 Pt 1):492-496. https://doi.org/10.1164/ajrccm.156.2.9702032
Perrier A, Desmarais S, Miron MJ, et al. Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet. 1999;353(9148):190-195. https://doi.org/10.1016/S0140-6736(98)05248-9
Perrier A, Howarth N, Didier D, et al. Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism. Ann Intern Med. 2001;135(2):88-97.
Perrier A, Roy PM, Aujesky D, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. 2004;116(5):291-299. https://doi.org/10.1016/j.amjmed.2003.09.041
Perrier A, Roy PM, Sanchez O, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005;352(17):1760-1768. https://doi.org/10.1056/NEJMoa042905
Righini M, Le Gal G, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008;371(9621):1343-1352. https://doi.org/10.1016/S0140-6736(08)60594-2
Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-Dimer cutoff levels to rule out pulmonary embolism. JAMA. 2014;311(11):1117-1124. https://doi.org/10.1001/jama.2014.2135
Roy PM, Meyer G, Vielle B, et al. Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med. 2006;144(3):157-164.
Cooper J. Improving the diagnosis of pulmonary embolism in the emergency department. BMJ Qual Improv Rep. 2015;4(1):u208698.w4222. https://doi.org/10.1136/bmjquality.u208698.w4222
Runyon MS, Beam DM, King MC, Lipford EH, Kline JA. Comparison of the simplify D-dimer assay performed at the bedside with a laboratory-based quantitative D-dimer assay for the diagnosis of pulmonary embolism in a low prevalence emergency department population. Emerg Med J. 2008;25(2):70-75. https://doi.org/10.1136/emj.2007.048918
Sanjuan P, Rodriguez-Nunez N, Rabade C, et al. Probability scores and diagnostic algorithms in pulmonary embolism: are they followed in clinical practice? [Spanish]. Arch Bronconeumol. 2014;50(5):172-178.
Serpytis R, Navickaite A, Daskeviciute A, Laucevicius A, Serpytis P. The clinical characteristics and diagnostic values of the Wells and revised Geneva scores combined with Ddimer for acute pulmonary embolism in nonelderly and elderly patients. Acute Cardiovasc Care Eur Heart J Suppl. 2016;2016:F58.
Strauss BJ, Packer N, Lipkus M, McLeod SL, Klingel M, Dukelow A. Emergency department diagnosis of pulmonary embolism: use of D-dimer, CT pulmonary angiography, and VQ scanning. Can J Emerg Med. 2014;16:S110.
Tsimogianni AM, Rovina N, Porfyridis I, et al. Clinical prediction of pulmonary embolism in respiratory emergencies. Thromb Res. 2011;127(5):411-417. https://doi.org/10.1016/j.thromres.2011.02.002
Turedi S, Gunduz A, Mentese A, et al. The value of ischemia-modified albumin compared with d-dimer in the diagnosis of pulmonary embolism. Respir Res. 2008;9:49. https://doi.org/10.1186/1465-9921-9-49
van Belle A, Buller HR, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295(2):172-179. https://doi.org/10.1001/jama.295.2.172
van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet. 2017;390(10091):289-297. https://doi.org/10.1016/S0140-6736(17)30885-1
Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. https://doi.org/10.1016/j.annemergmed.2004.04.002
Yetgin GO, Aydin SA, Koksal O, Ozdemir F, Mert DK, Torun G. Clinical probability and risk analysis of patients with suspected pulmonary embolism. World J Emerg Med. 2014;5(4):264-269. https://doi.org/10.5847/wjem.j.issn.1920-8642.2014.04.004
Courtney DM, Kline JA, Kabrhel C, et al. Clinical features from the history and physical examination that predict the presence or absence of pulmonary embolism in symptomatic emergency department patients: results of a prospective, multicenter study. Ann Emerg Med. 2010;55(4):307-315.e1. https://doi.org/10.1016/j.annemergmed.2009.11.010
Yoon YH, Lee SW, Jung DM, Moon SW, Horn JK, Hong YS. The additional use of end-tidal alveolar dead space fraction following D-dimer test to improve diagnostic accuracy for pulmonary embolism in the emergency department. Emerg Med J. 2010;27(9):663-667. https://doi.org/10.1136/emj.2008.071118
Yüksel M, Pekdemir M, Yilmaz S, Yaka E, Kartal AG. Diagnostic accuracy of noninvasive end-tidal carbon dioxide measurement in emergency department patients with suspected pulmonary embolism84-90. Turkish J Med Sci. 2016;46(1):84-90. https://doi.org/10.3906/sag-1404-108
Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107.
Roy PM, Durieux P, Gillaizeau F, et al. A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial. Ann Intern Med. 2009;151(10):677-686. https://doi.org/10.7326/0003-4819-151-10-200911170-00003
Dunn KL, Wolf JP, Dorfman DM, Fitzpatrick P, Baker JL, Goldhaber SZ. Normal D-dimer levels in emergency department patients suspected of acute pulmonary embolism. J Am Coll Cardiol. 2002;40(8):1475-1478. S0735109702021721.
Farrell S, Hayes T, Shaw M. A negative SimpliRED D-dimer assay result does not exclude the diagnosis of deep vein thrombosis or pulmonary embolus in emergency department patients. Ann Emerg Med. 2000;35(2):121-125. https://doi.org/10.1016/S0196-0644(00)70130-2
Friera-Reyes A, Caballero P, Ruiz-Gimenez N, et al. Usefulness of fast ELISA determination of D-dimer levels for diagnosing pulmonary embolism in an emergency room. [Spanish]. Arch Bronconeumol. 2005;41(9):499-504.
Galipienzo J, Garcia de Tena J, Flores J, Alvarez C, Garcia-Avello A, Arribas I. Effectiveness of a diagnostic algorithm combining clinical probability, D-dimer testing, and computed tomography in patients with suspected pulmonary embolism in an emergency department. Rom J Intern Med. 2012;50(3):195-202.
Ghanima W, Almaas V, Aballi S, et al. Management of suspected pulmonary embolism (PE) by D-dimer and multi-slice computed tomography in outpatients: an outcome study. J Thromb Haemost. 2005;3(9):1926-1932.
Gagnon MP, Sánchez E, Pons JMV. From recommendation to action: psychosocial factors influencing physician intention to use Health Technology Assessment (HTA) recommendations. Implement Sci. 2006;1(1):8. https://doi.org/10.1186/1748-5908-1-8
Danielsson M, Nilsen P, Rutberg H, Carlfjord S. The professional culture among physicians in Sweden: potential implications for patient safety. BMC Health Serv Res. 2018;18(1): https://doi.org/10.1186/s12913-018-3328-y
Chan TM, Mercuri M, Turcotte M, Gardiner E, Sherbino J, de Wit K. Making decisions in the era of the clinical decision rule: how emergency physicians use clinical decision rules. Acad Med. 2020;95:1230-1237.
Gyftopoulos S, Smith SW, Simon E, Kuznetsova M, Horwitz LI, Makarov DV. Qualitative study to understand ordering of CT angiography to diagnose pulmonary embolism in the emergency room setting. J Am Coll Radiol. 2018;15(9):1276-1284. https://doi.org/10.1016/j.jacr.2017.08.022
Liao JM, Fleisher LA, Navathe AS. Increasing the value of social comparisons of physician performance using norms. JAMA. 2016;316(11):1151-1152. https://doi.org/10.1001/jama.2016.10094
Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. https://doi.org/10.1111/j.1538-7836.2008.02944.x
Van Der Pol LM, Van Der Hulle T, Mairuhu ATA, Huisman MV, Klok FA. Combination of pulmonary embolism rule-out criteria and YEARS algorithm in a European cohort of patients with suspected pulmonary embolism. Thromb Haemost. 2018;118(3):547-552. https://doi.org/10.1055/s-0038-1623535
Freund Y, Cachanado M, Aubry A, et al. Effect of the pulmonary embolism rule-out criteria on subsequent thromboembolic events among low-risk emergency department patients the PROPER randomized clinical trial. JAMA. 2018;319(6):559-566. https://doi.org/10.1001/jama.2017.21904
Truffault B, Robin P, Tromeur C, et al. Time trend analysis of pulmonary embolism diagnosis with single-photon emission computed tomography ventilation/perfusion imaging. Nucl Med Commun. 2019;40(6):576-582. https://doi.org/10.1097/MNM.0000000000000990
Wolf SJ, McCubbin TR, Nordenholz KE, Naviaux NW, Haukoos JS. Assessment of the pulmonary embolism rule-out criteria rule for evaluation of suspected pulmonary embolism in the emergency department. Am J Emerg Med. 2008;26(2):181-185. https://doi.org/10.1016/j.ajem.2007.04.026
Hoellerich VL, Wington RS. Diagnosing pulmonary embolism using clinical findings. Arch Intern Med. 1986;146:1699-1704.
Celi A, Palla A, Petruzzelli S, et al. Prospective study of a standardized questionnaire to improve clinical estimate of pulmonary embolism. Chest. 1989;95:332-337.