Emergency evaluation for pulmonary embolism, part 1

Clinical factors that increase risk

Jeffrey Kline, Christopher Kabrhel

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background Pulmonary embolism (PE) can be fatal, but profligate testing for PE can harm patients. Objectives With consideration of potential medicolegal implications, this two-part review provides current evidence about the care of patients with suspected and diagnosed PE in the emergency department (ED) setting. Discussion In part 1, we review published evidence to describe the epidemiology, risk factors, and clinical presentation of PE in the ED setting. Older age, surgery requiring endotracheal intubation within the past 30 days, new use of oral contraceptives, and prior unprovoked venous thromboembolism in nonanticoagulated patients are clear risk factors for PE in ED patients. Recent history of unexplained dyspnea, pleuritic chest pain, and hemoptysis increase probability, but the effect of syncope is less clear. Treated and inactive cancer, smoking, obesity, and pregnancy have not been found to increase the probability of PE in symptomatic ED patients. Unexplained dyspnea, tachycardia, and a low pulse oximetry reading increase probability of PE. Finding of wheezing on lung auscultation reduces the probability of PE, and findings that suggest deep venous thrombosis increase the probability of PE. Conclusions Understanding of risk factors, historical data, and physical findings that have been found to increase or decrease the probability of PE in symptomatic ED patients can help create rational guidelines for the diagnostic approach to PE.

Original languageEnglish
Pages (from-to)771-780
Number of pages10
JournalJournal of Emergency Medicine
Volume48
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Pulmonary Embolism
Emergencies
Hospital Emergency Service
Dyspnea
Patient Harm
Auscultation
Oximetry
Intratracheal Intubation
Hemoptysis
Venous Thromboembolism
Respiratory Sounds
Syncope
Oral Contraceptives
Chest Pain
Tachycardia
Venous Thrombosis
Reading
Patient Care
Epidemiology
Obesity

Keywords

  • decision making
  • defensive medicine
  • diagnosis
  • medicolegal
  • pregnancy
  • pulmonary embolism
  • venous thromboembolism

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Emergency evaluation for pulmonary embolism, part 1 : Clinical factors that increase risk. / Kline, Jeffrey; Kabrhel, Christopher.

In: Journal of Emergency Medicine, Vol. 48, No. 6, 01.06.2015, p. 771-780.

Research output: Contribution to journalArticle

@article{b823bcd1b59f4822b73c588dc8e9a43a,
title = "Emergency evaluation for pulmonary embolism, part 1: Clinical factors that increase risk",
abstract = "Background Pulmonary embolism (PE) can be fatal, but profligate testing for PE can harm patients. Objectives With consideration of potential medicolegal implications, this two-part review provides current evidence about the care of patients with suspected and diagnosed PE in the emergency department (ED) setting. Discussion In part 1, we review published evidence to describe the epidemiology, risk factors, and clinical presentation of PE in the ED setting. Older age, surgery requiring endotracheal intubation within the past 30 days, new use of oral contraceptives, and prior unprovoked venous thromboembolism in nonanticoagulated patients are clear risk factors for PE in ED patients. Recent history of unexplained dyspnea, pleuritic chest pain, and hemoptysis increase probability, but the effect of syncope is less clear. Treated and inactive cancer, smoking, obesity, and pregnancy have not been found to increase the probability of PE in symptomatic ED patients. Unexplained dyspnea, tachycardia, and a low pulse oximetry reading increase probability of PE. Finding of wheezing on lung auscultation reduces the probability of PE, and findings that suggest deep venous thrombosis increase the probability of PE. Conclusions Understanding of risk factors, historical data, and physical findings that have been found to increase or decrease the probability of PE in symptomatic ED patients can help create rational guidelines for the diagnostic approach to PE.",
keywords = "decision making, defensive medicine, diagnosis, medicolegal, pregnancy, pulmonary embolism, venous thromboembolism",
author = "Jeffrey Kline and Christopher Kabrhel",
year = "2015",
month = "6",
day = "1",
doi = "10.1016/j.jemermed.2014.12.040",
language = "English",
volume = "48",
pages = "771--780",
journal = "Journal of Emergency Medicine",
issn = "0736-4679",
publisher = "Elsevier USA",
number = "6",

}

TY - JOUR

T1 - Emergency evaluation for pulmonary embolism, part 1

T2 - Clinical factors that increase risk

AU - Kline, Jeffrey

AU - Kabrhel, Christopher

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Background Pulmonary embolism (PE) can be fatal, but profligate testing for PE can harm patients. Objectives With consideration of potential medicolegal implications, this two-part review provides current evidence about the care of patients with suspected and diagnosed PE in the emergency department (ED) setting. Discussion In part 1, we review published evidence to describe the epidemiology, risk factors, and clinical presentation of PE in the ED setting. Older age, surgery requiring endotracheal intubation within the past 30 days, new use of oral contraceptives, and prior unprovoked venous thromboembolism in nonanticoagulated patients are clear risk factors for PE in ED patients. Recent history of unexplained dyspnea, pleuritic chest pain, and hemoptysis increase probability, but the effect of syncope is less clear. Treated and inactive cancer, smoking, obesity, and pregnancy have not been found to increase the probability of PE in symptomatic ED patients. Unexplained dyspnea, tachycardia, and a low pulse oximetry reading increase probability of PE. Finding of wheezing on lung auscultation reduces the probability of PE, and findings that suggest deep venous thrombosis increase the probability of PE. Conclusions Understanding of risk factors, historical data, and physical findings that have been found to increase or decrease the probability of PE in symptomatic ED patients can help create rational guidelines for the diagnostic approach to PE.

AB - Background Pulmonary embolism (PE) can be fatal, but profligate testing for PE can harm patients. Objectives With consideration of potential medicolegal implications, this two-part review provides current evidence about the care of patients with suspected and diagnosed PE in the emergency department (ED) setting. Discussion In part 1, we review published evidence to describe the epidemiology, risk factors, and clinical presentation of PE in the ED setting. Older age, surgery requiring endotracheal intubation within the past 30 days, new use of oral contraceptives, and prior unprovoked venous thromboembolism in nonanticoagulated patients are clear risk factors for PE in ED patients. Recent history of unexplained dyspnea, pleuritic chest pain, and hemoptysis increase probability, but the effect of syncope is less clear. Treated and inactive cancer, smoking, obesity, and pregnancy have not been found to increase the probability of PE in symptomatic ED patients. Unexplained dyspnea, tachycardia, and a low pulse oximetry reading increase probability of PE. Finding of wheezing on lung auscultation reduces the probability of PE, and findings that suggest deep venous thrombosis increase the probability of PE. Conclusions Understanding of risk factors, historical data, and physical findings that have been found to increase or decrease the probability of PE in symptomatic ED patients can help create rational guidelines for the diagnostic approach to PE.

KW - decision making

KW - defensive medicine

KW - diagnosis

KW - medicolegal

KW - pregnancy

KW - pulmonary embolism

KW - venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=84930177387&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930177387&partnerID=8YFLogxK

U2 - 10.1016/j.jemermed.2014.12.040

DO - 10.1016/j.jemermed.2014.12.040

M3 - Article

VL - 48

SP - 771

EP - 780

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

SN - 0736-4679

IS - 6

ER -