Use of the alveolar-arterial oxygen gradient in the diagnosis of pulmonary embolism

Michael J. McFarlane, Thomas Imperiale

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

background: Arterial blood gas (ABG) values and the alveolar-arterial oxygen (A-a) gradient are sensitive indicators of pulmonary pathology. Alone, they are not diagnostic of pulmonary embolism (PE), but they may be useful in excluding the diagnosis of PE if their values fall within the normal range. The purpose of this study was to determine the diagnostic value of a normal A-a gradient in ruling out PE. patients and methods: The Derivation Set came from the records of all patients at Cleveland MetroHealth Medical Center who received a ventilation/perfusion (V/Q) scan for suspected PE in 1988 or 1989. Demographic and clinical data were obtained that included risk factors, symptoms, signs, and laboratory tests. A-a gradients were calculated using a standard equation, a normal gradient was defined as less than or equal to (age/4 + 4). The A-a gradient was examined before and after controlling for PE risk factors. The Validation Set was comprised of patients who had V/Q scans in 1987 and 1990. results: Among the 873 patients in the Derivation Set, 540 had simultaneous room air ABG determinations. Of these patients, 109 (20%) had a discharge diagnosis of PE. Only 1 of 57 (1.8%; 95% confidence interval [CI]: 0.9%-10.7%) patients without a history of PE or deep venous thrombosis (DVT) and with a normal A-a gradient had PE. Among the 805 V/Q patients in the Validation Set, 489 had simultaneous room air/ ABG determinations. Of these, 75 (15%) had PE. Only 1 of 54 (1.9%; 95% CI: 0.1%-11.2%) patients without a history of PE or DVT and with a normal A-a gradient had PE. conclusions: A normal A-a gradient among patients without a history of PE or DVT makes the diagnosis of PE unlikely. Further diagnostic evaluation may be unnecessary in this subgroup of patients.

Original languageEnglish (US)
Pages (from-to)57-62
Number of pages6
JournalThe American Journal of Medicine
Volume96
Issue number1
DOIs
StatePublished - 1994
Externally publishedYes

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Pulmonary Embolism
Oxygen
Venous Thrombosis
Gases
Reference Values
Air
Confidence Intervals
Signs and Symptoms
Ventilation
Perfusion
Demography
Pathology

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Use of the alveolar-arterial oxygen gradient in the diagnosis of pulmonary embolism. / McFarlane, Michael J.; Imperiale, Thomas.

In: The American Journal of Medicine, Vol. 96, No. 1, 1994, p. 57-62.

Research output: Contribution to journalArticle

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abstract = "background: Arterial blood gas (ABG) values and the alveolar-arterial oxygen (A-a) gradient are sensitive indicators of pulmonary pathology. Alone, they are not diagnostic of pulmonary embolism (PE), but they may be useful in excluding the diagnosis of PE if their values fall within the normal range. The purpose of this study was to determine the diagnostic value of a normal A-a gradient in ruling out PE. patients and methods: The Derivation Set came from the records of all patients at Cleveland MetroHealth Medical Center who received a ventilation/perfusion (V/Q) scan for suspected PE in 1988 or 1989. Demographic and clinical data were obtained that included risk factors, symptoms, signs, and laboratory tests. A-a gradients were calculated using a standard equation, a normal gradient was defined as less than or equal to (age/4 + 4). The A-a gradient was examined before and after controlling for PE risk factors. The Validation Set was comprised of patients who had V/Q scans in 1987 and 1990. results: Among the 873 patients in the Derivation Set, 540 had simultaneous room air ABG determinations. Of these patients, 109 (20{\%}) had a discharge diagnosis of PE. Only 1 of 57 (1.8{\%}; 95{\%} confidence interval [CI]: 0.9{\%}-10.7{\%}) patients without a history of PE or deep venous thrombosis (DVT) and with a normal A-a gradient had PE. Among the 805 V/Q patients in the Validation Set, 489 had simultaneous room air/ ABG determinations. Of these, 75 (15{\%}) had PE. Only 1 of 54 (1.9{\%}; 95{\%} CI: 0.1{\%}-11.2{\%}) patients without a history of PE or DVT and with a normal A-a gradient had PE. conclusions: A normal A-a gradient among patients without a history of PE or DVT makes the diagnosis of PE unlikely. Further diagnostic evaluation may be unnecessary in this subgroup of patients.",
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