Systematic review and meta-analysis of outcomes in patients with suspected pulmonary embolism

被引：10

作者：

Patel, Parth ^{[1
]}

Patel, Payal ^{[2
]}

Bhatt, Meha ^{[3
]}

Braun, Cody ^{[4
]}

Begum, Housne ^{[3
]}

Nieuwlaat, Robby ^{[3
]}

Khatib, Rasha ^{[5
]}

Martins, Carolina C. ^{[3
]}

Zhang, Yuan ^{[3
]}

Etxeandia-Ikobaltzeta, Itziar ^{[3
]}

Varghese, Jamie ^{[2
]}

Alturkmani, Hani ^{[2
]}

Bahaj, Waled ^{[2
]}

Baig, Mariam ^{[2
]}

Kehar, Rohan ^{[6
]}

Mustafa, Ahmad ^{[2
]}

Ponnapureddy, Rakesh ^{[2
]}

Sethi, Anchal ^{[2
]}

Thomas, Merrill ^{[2
]}

Wooldridge, David ^{[2
]}

Lim, Wendy ^{[7
,8
]}

Bates, Shannon M. ^{[7
,9
]}

Lang, Eddy ^{[10
]}

Le Gal, Gregoire ^{[11
]}

Haramati, Linda B. ^{[12
,13
]}

Kline, Jeffrey ^{[14
]}

Righini, Marc ^{[15
]}

Wiercioch, Wojtek ^{[3
]}

Schunemann, Holger ^{[3
,7
]}

Mustafa, Reem A. ^{[3
,16
]}

机构：

[1] Univ Missouri, Dept Med, Kansas City, MO 64110 USA

[2] Univ Illinois, Dept Emergency Med, Chicago, IL USA

[3] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[4] Loyola Univ Med Ctr, Dept Med, Maywood, IL 60153 USA

[5] Advocate Hlth Care, Advocate Res Inst, Oak Lawn, IL USA

[6] Western Univ, Div Hematol, London, ON, Canada

[7] McMaster Univ, Dept Med, Hamilton, ON, Canada

[8] McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON, Canada

[9] McMaster Univ, Thrombosis & Atherosclerosis Res Inst, Hamilton, ON, Canada

[10] Univ Calgary, Cumming Sch Med, Dept Emergency Med, Calgary, AB, Canada

[11] Univ Ottawa, Ottawa Hosp Res Inst, Dept Med, Ottawa, ON, Canada

[12] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Radiol, Bronx, NY 10467 USA

[13] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Med, Bronx, NY 10467 USA

[14] Indiana Univ Sch Med, Dept Emergency Med, Indianapolis, IN 46202 USA

[15] Geneva Univ Hosp & Fac Med, Dept Med Specialties, Div Angiol & Hemostasis, Geneva, Switzerland

[16] Univ Kansas, Med Ctr, Dept Med, Div Nephrol & Hypertens, 3901 Rainbow Blvd,MS3002, Kansas City, KS 66160 USA

来源：

BLOOD ADVANCES | 2021年 / 5卷 / 08期

关键词：

D-DIMER LEVELS; VENOUS THROMBOEMBOLISM; CLINICAL PROBABILITY; DIAGNOSIS; EMERGENCY; GUIDELINES; MANAGEMENT;

D O I：

10.1182/bloodadvances.2020002398

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Prompt evaluation and therapeutic intervention of suspected pulmonary embolism (PE) are of paramount importance for improvement in outcomes. We systematically reviewed outcomes inpatients with suspected PE, including mortality, incidence of recurrent PE, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included 22 studies with 15 865 patients. Among patients who were diagnosed with PE and discharged with anticoagulation, 3-month follow-up revealed that all-cause mortality was 5.69% (91/1599; 95% confidence interval [CI], 4.56-6.83), mortality from PE was 1.19% (19/1597; 9S% CI, 0.66-1.72), recurrent venous thromboembolism (VTE) occurred in 1.38% (22/1597; 95% CI: 0.81-1.95), and major bleeding occurred in 0.90% (2/221%; 95% CI, 0-2.15). In patients with a low pretest probability (PTP) and negative D-dimer, 3-month follow-up revealed mortality from PE was 0% (0/808) and incidence of VTE was 0.37% (4/1094; 95% CI: 0.007-0.72). In patients with intermediate PTP and negative D-dimer, 3-month follow-up revealed that mortality from PE was 0% (0/2747) and incidence of VTE was 0.46% (14/3015; 95% CI: 0.22-0.71). In patients with high PTP and negative computed tomography (CT) scan, 3-month follow-up revealed mortality from PE was 0% (0/651) and incidence of VTE was 0.84% (11/1302; 95% CI: 0.35-1.34). We further summarize outcomes evaluated by various diagnostic tests and diagnostic pathways (ie, D-dieter followed by CT scan).

引用

页码：2237 / 2244

页数：8

共 38 条

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