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Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts

BACKGROUND: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosin...

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Autores principales: den Exter, Paul L., Kroft, Lucia J. M., Gonsalves, Carol, Le Gal, Gregoire, Schaefer‐Prokop, Cornelia M., Carrier, Marc, Huisman, Menno V., Klok, Frederikus A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695556/
https://www.ncbi.nlm.nih.gov/pubmed/33313465
http://dx.doi.org/10.1002/rth2.12422
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author den Exter, Paul L.
Kroft, Lucia J. M.
Gonsalves, Carol
Le Gal, Gregoire
Schaefer‐Prokop, Cornelia M.
Carrier, Marc
Huisman, Menno V.
Klok, Frederikus A.
author_facet den Exter, Paul L.
Kroft, Lucia J. M.
Gonsalves, Carol
Le Gal, Gregoire
Schaefer‐Prokop, Cornelia M.
Carrier, Marc
Huisman, Menno V.
Klok, Frederikus A.
author_sort den Exter, Paul L.
collection PubMed
description BACKGROUND: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. OBJECTIVES: We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. METHODS: Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. RESULTS: Twenty‐nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of ≤1 mm. These criteria were approved by 83% of the clinical venous thromboembolism (VTE) specialists. The clinical expert panel favored anticoagulant treatment in case of prior VTE, antiphospholipid syndrome, pregnancy, cancer, and proximal deep vein thrombosis. CONCLUSION: The results of this analysis provide standard radiological criteria for ssPE that may be applicable in both clinical trials and practice.
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spelling pubmed-76955562020-12-10 Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts den Exter, Paul L. Kroft, Lucia J. M. Gonsalves, Carol Le Gal, Gregoire Schaefer‐Prokop, Cornelia M. Carrier, Marc Huisman, Menno V. Klok, Frederikus A. Res Pract Thromb Haemost Original Articles ‐ Thrombosis BACKGROUND: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. OBJECTIVES: We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. METHODS: Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. RESULTS: Twenty‐nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of ≤1 mm. These criteria were approved by 83% of the clinical venous thromboembolism (VTE) specialists. The clinical expert panel favored anticoagulant treatment in case of prior VTE, antiphospholipid syndrome, pregnancy, cancer, and proximal deep vein thrombosis. CONCLUSION: The results of this analysis provide standard radiological criteria for ssPE that may be applicable in both clinical trials and practice. John Wiley and Sons Inc. 2020-10-01 /pmc/articles/PMC7695556/ /pubmed/33313465 http://dx.doi.org/10.1002/rth2.12422 Text en © 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles ‐ Thrombosis
den Exter, Paul L.
Kroft, Lucia J. M.
Gonsalves, Carol
Le Gal, Gregoire
Schaefer‐Prokop, Cornelia M.
Carrier, Marc
Huisman, Menno V.
Klok, Frederikus A.
Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts
title Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts
title_full Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts
title_fullStr Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts
title_full_unstemmed Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts
title_short Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts
title_sort establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: a delphi analysis of experts
topic Original Articles ‐ Thrombosis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695556/
https://www.ncbi.nlm.nih.gov/pubmed/33313465
http://dx.doi.org/10.1002/rth2.12422
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