Cargando…

Capnometry in suspected pulmonary embolism with positive D-dimer in the field

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Rumpf, Tadeja Hernja, Križmarić, Miljenko, Grmec, Štefek
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811920/
https://www.ncbi.nlm.nih.gov/pubmed/19995420
http://dx.doi.org/10.1186/cc8197
_version_ 1782176811567808512
author Rumpf, Tadeja Hernja
Križmarić, Miljenko
Grmec, Štefek
author_facet Rumpf, Tadeja Hernja
Križmarić, Miljenko
Grmec, Štefek
author_sort Rumpf, Tadeja Hernja
collection PubMed
description 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 (PetCO(2)) for evaluation of suspected PE with abnormal concentrations of D-dimer in prehospital emergency setting. METHODS: We assessed clinical probability of PE and PetCO(2 )measurement in 100 consecutive patients with suspected PE and positive D-dimer in the field. PetCO(2 )> 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. PetCO(2 )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 PetCO(2 )(sensitivity: 100%, 95% CI: 89 to 100%) and twenty-eight patients (28%) had both a high clinical probability (PE likely) and abnormal PetCO(2 )(specificity: 93.2%, 95% CI: 83 to 98%). CONCLUSIONS: The combination of clinical probability and PetCO(2) may safely rule out PE in patients with suspected PE and positive D-dimer in the prehospital setting.
format Text
id pubmed-2811920
institution National Center for Biotechnology Information
language English
publishDate 2009
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-28119202010-01-28 Capnometry in suspected pulmonary embolism with positive D-dimer in the field Rumpf, Tadeja Hernja Križmarić, Miljenko Grmec, Štefek Crit Care Research 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 (PetCO(2)) for evaluation of suspected PE with abnormal concentrations of D-dimer in prehospital emergency setting. METHODS: We assessed clinical probability of PE and PetCO(2 )measurement in 100 consecutive patients with suspected PE and positive D-dimer in the field. PetCO(2 )> 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. PetCO(2 )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 PetCO(2 )(sensitivity: 100%, 95% CI: 89 to 100%) and twenty-eight patients (28%) had both a high clinical probability (PE likely) and abnormal PetCO(2 )(specificity: 93.2%, 95% CI: 83 to 98%). CONCLUSIONS: The combination of clinical probability and PetCO(2) may safely rule out PE in patients with suspected PE and positive D-dimer in the prehospital setting. BioMed Central 2009 2009-12-08 /pmc/articles/PMC2811920/ /pubmed/19995420 http://dx.doi.org/10.1186/cc8197 Text en Copyright ©2009 Rumpf et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Rumpf, Tadeja Hernja
Križmarić, Miljenko
Grmec, Štefek
Capnometry in suspected pulmonary embolism with positive D-dimer in the field
title Capnometry in suspected pulmonary embolism with positive D-dimer in the field
title_full Capnometry in suspected pulmonary embolism with positive D-dimer in the field
title_fullStr Capnometry in suspected pulmonary embolism with positive D-dimer in the field
title_full_unstemmed Capnometry in suspected pulmonary embolism with positive D-dimer in the field
title_short Capnometry in suspected pulmonary embolism with positive D-dimer in the field
title_sort capnometry in suspected pulmonary embolism with positive d-dimer in the field
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811920/
https://www.ncbi.nlm.nih.gov/pubmed/19995420
http://dx.doi.org/10.1186/cc8197
work_keys_str_mv AT rumpftadejahernja capnometryinsuspectedpulmonaryembolismwithpositiveddimerinthefield
AT krizmaricmiljenko capnometryinsuspectedpulmonaryembolismwithpositiveddimerinthefield
AT grmecstefek capnometryinsuspectedpulmonaryembolismwithpositiveddimerinthefield