CLINICAL SIGNS AND SYMPTOMS IN PULMONARY-EMBOLISM - A REASSESSMENT

Citation
Jm. Hoffman et al., CLINICAL SIGNS AND SYMPTOMS IN PULMONARY-EMBOLISM - A REASSESSMENT, Clinical nuclear medicine, 19(9), 1994, pp. 803-808
Citations number
39
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Radiology,Nuclear Medicine & Medical Imaging
Journal title
ISSN journal
0363-9762
Volume
19
Issue
9
Year of publication
1994
Pages
803 - 808
Database
ISI
SICI code
0363-9762(1994)19:9<803:CSASIP>2.0.ZU;2-U
Abstract
The clinical diagnosis of pulmonary embolism (PE) remains difficult de spite years of investigation. The clinical signs and symptoms of pulmo nary embolism are numerous, but they are not diagnostically accurate. Radionuclide ventilation perfusion imaging (VQ) has become an importan t adjunct in screening patients for suspected PE. This study re-evalua tes the predictive capabilities of various clinical signs and symptoms in a population of patients in whom angiography was thought to be nec essary because of clinical concern for PE. One hundred one patients wi th suspected PE were retrospectively identified. Clinical information on them was complete, and laboratory studies, VQ imaging, and pulmonar y angiography were performed. Thirty-seven clinical signs, symptoms, a nd other characteristics were individually compared for patients whose angiographic results were positive or negative for PE. Modifying or i nteractive effects on PE were then examined with logistic regression a nalysis. Several clinical conditions, including immobilization and rec ent surgery, were significantly associated with PE. Shortness of breat h and history of smoking were significantly associated with negative r esults on pulmonary angiography. A ''high probability'' VQ scan was hi ghly predictive (P < .0001) of positive results on angiography. When i nteractive factors for PE were examined, lack of shortness of breath a nd arterial pH less than or equal to 7.45, lack of shortness of breath and respiratory rate >23, diaphoresis in a nonsmoker and immobilized female, were significantly associated with PE. This study again docume nts the difficulty in using clinical criteria-including signs, symptom s, and laboratory determinations-to predict PE accurately, even in a p opulation in which PE was of clinical concern irrespective of the VQ s can results. The extremely high predictive ability of the VQ scan rein forces its importance in the evaluation of the patient with suspected PE.