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01. History of Cardiology
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32. Cardiovascular Nursing
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Age-dependence performance of diagnostic prediction rules for pulmonary embolism
Session:
Posters (Sessão 4 - Écran 8) - Doença Arterial Pulmonar - Foco na Embolia Pulmonar
Speaker:
Pedro Alves Da Silva
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.3 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Diagnostic Methods
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Pedro Alves da Silva; Beatriz Valente Silva; Carlos Mendonça; Luísa Urbano; Tiago Rodrigues; Cláudia Jorge; Rui Plácido; Joana Brito; Pedro Silvério António; Sara Couto Pereira; Fausto j. Pinto
Abstract
<p style="margin-right:-2px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction: </span></strong><span style="color:black">Ruling out pulmonary embolism (PE) through a combination of clinical assessment and D-dimer is crucial to avoid excessive computed tomography pulmonary angiography (CTPA). We aimed to compare the diagnostic accuracy of the standard approach based on Wells and Geneva scores combined with a standard D-dimer cut-off (500 ng/mL), with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in patients admitted to the Emergency Department (ED) due to PE suspicion.</span></span></span></p> <p style="margin-right:-2px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods: </span></strong><span style="color:black">Consecutive outpatients admitted to the ED who underwent CTPA due to PE suspicion were retrospectively evaluated. Sensitivity, specificity, positive and negative predictive values, likelihood ratios and diagnostic odds ratio were calculated and compared among the different diagnostic prediction rules.</span></span></span></p> <p style="margin-right:-2px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results: </span></strong><span style="color:black">We included 1402 patients (mean age 69 ± 18.32 years, 54% female), and PE was confirmed in 25% of them. </span></span></span></p> <p style="margin-right:-2px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Using an age-adjusted strategy increased specificity compared to the standard approach (p<0.001), with a non-significant decrease in sensitivity only in patients over the age of 70. YEARS and PEGeD algorithms, despite the most specific of all prediction rules for all spectrum of ages, were associated with a significant decrease in sensitivity (p<0.001) compared to the standard and age-adjusted approaches, particularly in patients under 60 years (sensitivity of 81% in patients aged between 51 and 60 years).</span></span></span></p> <p style="margin-right:-2px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusion: </span></strong><span style="color:black">Compared to the standard approach, all algorithms were associated with increased specificity. The age-adjusted strategy was the only one that was not associated with a significant decrease in sensitivity compared to the standard approach, allowing to reduce CTPA requests safely.</span></span></span></p>
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