In:
PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 10 ( 2022-10-18), p. e0276202-
Abstract:
Critically ill patients have a higher incidence of pulmonary embolism (PE) than non-critically ill patients, yet no diagnostic algorithm has been validated in this population, leading to the overuse of pulmonary artery computed tomographic angiogram (CTA). This study aimed to comparatively evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) combined with laboratory data versus CTA in predicting PE in critically ill patients. Methods A prospective diagnostic accuracy study. Critically ill patients with suspected acute PE undergoing CTA were prospectively enrolled. Demographic and clinical data were collected from electronic medical records. Blood samples were collected, and the Wells and revised Geneva scores were calculated. Standardized multiorgan POCUS and CTA were performed. The discriminatory power of multiorgan POCUS combined with biochemical markers was tested using ROC curves, and multivariate analysis was performed. Results A total of 88 patients were included, and 37 (42%) had PE. Multivariate analysis showed a relative risk (RR) of PE of 2.79 (95% CI, 1.61–4.84) for the presence of right ventricular (RV) dysfunction, of 2.54 (95% CI, 0.89–7.20) for D-dimer levels 〉 1000 ng/mL, and of 1.69 (95% CI, 1.12–2.63) for the absence of an alternative diagnosis to PE on lung POCUS or chest radiograph. The combination with the highest diagnostic accuracy for PE included the following variables: 1– POCUS transthoracic echocardiography with evidence of RV dysfunction; 2– lung POCUS or chest radiograph without an alternative diagnosis to PE; and 3– plasma D-dimer levels 〉 1000 ng/mL. Combining these three findings resulted in an area under the curve of 0.85 (95% CI, 0.77–0.94), with 50% sensitivity and 96% specificity. Conclusions Multiorgan POCUS combined with laboratory data has acceptable diagnostic accuracy for PE compared with CTA. The combined use of these methods might reduce CTA overuse in critically ill patients.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0276202
DOI:
10.1371/journal.pone.0276202.g001
DOI:
10.1371/journal.pone.0276202.t001
DOI:
10.1371/journal.pone.0276202.t002
DOI:
10.1371/journal.pone.0276202.t003
DOI:
10.1371/journal.pone.0276202.t004
DOI:
10.1371/journal.pone.0276202.s001
DOI:
10.1371/journal.pone.0276202.s002
DOI:
10.1371/journal.pone.0276202.s003
DOI:
10.1371/journal.pone.0276202.s004
DOI:
10.1371/journal.pone.0276202.s005
DOI:
10.1371/journal.pone.0276202.r001
DOI:
10.1371/journal.pone.0276202.r002
DOI:
10.1371/journal.pone.0276202.r003
DOI:
10.1371/journal.pone.0276202.r004
DOI:
10.1371/journal.pone.0276202.r005
DOI:
10.1371/journal.pone.0276202.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2267670-3
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