Accuracy of Multi-organ Ultrasound for the Diagnosis of Pulmonary Embolism

Azienda Ospedaliero-Universitaria Careggi357 enrolled

Overview

Patients with suspected Pulmonary Embolism (PE) and a high clinical probability or a high D-dimer level should undergo a second level diagnostic test such as Multidetector Computed Tomography Angiography (MCTPA). Unfortunately MCTPA involves radiation exposure, is expensive, is not feasible in unstable patients and has contraindications. UltraSound (US) is safe and rapidly available even in unstable patients. Many authors evaluated the diagnostic role of Compression Ultrasound Scan (CUS) for detecting limbs Deep Vein Thrombosis (DVT), TransThoracic Echocardiography (TTE) for detecting Right Ventricular Dysfunction (RVD) or Thoracic UltraSound (TUS) for detecting subpleural infarcts in patients with suspected PE. No previous studies have investigated the diagnostic accuracy of CUS, TTE and TUS combined (multiorgan US) for the diagnosis of PE. This study evaluates the diagnostic accuracy of multiorgan US. Methods. Consecutive patients that underwent MCTPA in the Emergency Department for clinical suspicion of PE and with a simplified Well's score\>4 (PE likely) or with a D-dimer value ≥500ng/ml were enrolled in the study. MCTPA was considered the gold standard for PE diagnosis. A multiorgan US was performed by an emergency physician sonographer before MCTPA. PE was considered echographically present if CUS was positive for DVT or TTE was positive for RVD or at least one pulmonary subpleural infarct was detected with TUS. The accuracy of the single and multiorgan US was calculated.

Study Type

OBSERVATIONAL

Enrollment

357

Conditions

Pulmonary Embolism

Interventions

A multiorgan ultrasound was performed by an emergency physician sonographer before MCTPA. Pulmonary embolism was considered echographically present if compression ultrasound was positive for deep vein thrombosis or transthoracic-echocardiography was positive for right ventricular dysfunction or at least one pulmonary subpleural infarct was detected with thoracic ultrasound.

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patients with clinical suspected pulmonary embolism * Simplified Well's score\>4 (PE likely) or D-dimer value ≥500ng/ml * Patients that undergo MCTPA in the Emergency Department for suspected pulmonary embolism Exclusion Criteria: * Refused consent * Less than 18 years old * Not possible to perform ultrasound scan within 3 hours before MCTPA

Locations (3)

Emergency Department Azienda Ospedaliera Universitaria Careggi

Florence, Tuscany, Italy

Department of Emergency Medicine, Pierantoni Morgagni Hospital

Forlì, Italy

Department of Emergency Medicine, San Luigi Gonzaga University Hospital

Torino, Italy

Outcomes

Primary Outcomes

Accuracy of ultrasound for the diagnosis of pulmonary embolism

Sensitivity, specificity, negative and positive predictive value, negative and positive likelihood ratio of limb, cardiac, thoracic and multi-organ ultrasound for the diagnosis of pulmonary embolism in the emergency department considering as gold standard the Multidetector Computed Tomography Angiography (MCTPA)

Time frame: The goldstandard for PE diagnosis is the MCTPA performed within 24 hours from ED presentation. The recruiting period is 5 months. There is not a follow-up for the included patients.