The Revised Diagnostic Strategy For Acute Pulmonary Embolism Based On Objective Examination

Objective:To develop a revised diagnostic strategy for acute pulmonary embolism basedon objective examination.Methods:A retrospective study was performed on425patients of suspected APTE forthe development dataset, who had undergone CTPA from January2009to December2012into the APTE group (161cases) and non-APTE group (264cases).Byanalyzing the frequency of risk factors, clinical symptoms and signs, as well aspart of the objective test results of this two groups, the APTE suspected indicatorswere extracted, the risk of the indicators were measured by multivariate logisticregression analysis and given corresponding points based onthe OR value. Formedby each indicator’s corresponding points, the clinical score would be revised,furthermore, it would develop the risk stratification through gathering furtherdistribution of plasma D-D testing and CUS results, in contribute to establish arevised diagnostic strategy for acute pulmonary embolism based on objectiveexamination.Results:1. According to the results of CTPA,161patients were diagnosed as APTE in425cases of suspected APTE patients, and diagnosis rate was38%.2. APTE group and non-APTE group were compared with gender, age, historyof cancer, the lead V1QR type and RBBB in ECG, urinary protein, and showed nosignificant difference (P>0.05).3.APTE group and non-APTE group were compared with APTEand DVT history, surgery and braking history, diabetes, syncope, hemopYyXOX, eaWY WaYe≥100beats/min, DVT signs, ECG abnormalities (V1-V4T-wave inversion/SIQIIITIII),abnormal echocardiography (RV enlargement/tricuspid moderate or severeregurgitation/increased pulmonary artery pressure), low hypocapnia, and showedstatistically significant (P <0.05).4. A new APTE statistics scale: APTE or DVT history (3points), surgeryorbraking history (3UUOTYX), caTceW (1UUOTYX), eSUUYyXOX (3UUOTYX), eaWY WaYe≥100times/min (1points), signs of DVT (2points), ECG abnormalities (2points),abnormal echocardiography (2points), low hypercapnia (1point). After theindividual risk scores were calculated, patients with a total score of4or less wereassigned to the low-probability category(264patients [62%]; prevalence of APTE,22.72%), those with a total score of5or higher to the high-probability category (161patients [38%];prevalence of APTE62.73%).5. No APTE UaYOeTYX D-dimer and CUS results were both negative.Conclusion:The revised clinical score based on the objective examination combined withD-dimer and CUSprovides a standardized assessment of the clinical probability ofAPTE. Applying this diagnostic strategy to emergency ward patients suspected ofhaving APTE could allow a more effective diagnostic process.