Tadeja Hernja Rumpf (Author), Miljenko Križmarić (Author), Štefek Grmec (Author)

Abstract

Introduction: Pulmonary embolism (PE) is one of the greatest diagnostic challenges in prehospital emergency setting. Most patients with suspected PE have a positive D-dimer and undergo diagnostic testing. Excluding PE with additional non-invasive tests would reduce the need for further imaging tests. We aimed to determine the effectiveness of combination of clinical probability and end-tidal carbon dioxide (PetCO2) for evaluation of suspected PE with abnormal concentrations of D-dimer in prehospital emergency setting. Methods: We assessed clinical probability of PE and PetCO2 measurement in 100 consecutive patients with suspected PE and positive D-dimer in the field. PetCO2 > 28 mmHg was considered as the best cut-off point. PE was excluded or confirmed by hospital physicians in the University Clinical Center Maribor by computer tomography (CT), ventilation/ perfusion scan echocardiography and pulmonary angiography. Results: PE was confirmed in 41 patients. PetCO2 had a sensitivity of 92.6% (95% CI, 79 to 98%), a negative predictive value of 94.2 % (95% CI, 83 to 99%), a specificity of 83 % (95% CI, 71 to 91%) and a positive predictive value of 79.2% (95% CI, 65 to 89%). Thirty-five patients (35%) had both a low (PE unlikely) clinical probability and a normal PetCO2 (sensitivity: 100%, 95% CI: 89 to 100%) and twenty-eight patients (28%) had both a high clinical probability (PE likely) and abnormal PetCO2 (specificity: 93.2%, 95% CI: 83 to 98%). Conclusions: The combination of clinical probability and PetCO2 may safely rule out PE in patients with suspected PE and positive D-dimer in the prehospital setting.

Keywords

kapnometrija;

Data

Language: English
Year of publishing:
Typology: 1.01 - Original Scientific Article
Organization: UM FZV - Faculty of Health Sciences
UDC: 616.24-005-083.98
COBISS: 3502399 Link will open in a new window
ISSN: 1466-609X
Views: 884
Downloads: 330
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Other data

Secondary language: Slovenian
Secondary keywords: Pulmonary Embolism;diagnosis;Pljučna embolija;Diagnostika;Blood Gas Monitoring, Transcutaneous;Krvni plini, transkutano merjenje;Emergency Medicine;Urgentna medicina;Carbon Dioxide;Ogljikov dioksid;
URN: URN:SI:UM:
Type (COBISS): Scientific work
Pages: str. R196 [1-9]
Volume: ǂVol. ǂ13
Issue: ǂno. ǂ6
Chronology: 2009
DOI: 10.1186/cc8197
ID: 10845021