Universal Journal of Public Health Vol. 7(1), pp. 19 - 29
DOI: 10.13189/ujph.2019.070103
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Acute Pulmonary Thromboembolism Retrospective Auditory - The Benefits of Clinical Predictive Tools

Bruno Sousa Dos Santos ^1,2,*, Maya Wielert ³, Ieva Krieva ^1,2, Kathryn Mullan ⁴, Sandra Seimane ², Aleksejs Visnakovs ², Olegs Sabelnikovs ^1,5
1 Department of Anesthesiology, Faculty of Medicine, Riga Stradins University, Riga, Latvia
² Department of Emergency, Riga East Clinical University Hospital (RECUH), Riga, Latvia
³ Faculty of Medical, University of Lübeck, Lübeck, Germany
⁴ Department of Medicine, Altnagelvin Area Hospital, Derry/Londonderry, Northern Ireland, UK
⁵ Department of Anesthesiology, Pauls Stradins Clinical University Hospital, Riga, Latvia

ABSTRACT

Several studies in recent years have identified the importance of developing a more standardized diagnostic approach to patients suspected of acute pulmonary embolism (PE). Still many doctors prefer a theoretical approach to the diagnosis of PE without the use of pre-test clinical predictive tools. Through the process of audit, we collected data available from the files of patients who underwent computer tomography pulmonary angiography (CTPA) and tested this data within the pre-test probability tool "Wells criteria score". Additionally, other important variables that were previously validated as well as those with possible diagnostic value were also analysed, as these may prove to be useful indicators to further develop the pathway towards a more efficient diagnosis of PE. The results within this study were compared to similar studies. With the aim of understanding the possible benefits of a more purposely structured approach, this study ultimately intends to support the development of PE protocols towards a more standardized approach to its diagnosis. Subsequently, it seeks to promote improvement in patient safety and accuracy in diagnosis as well as clinical decision-making. The main results in this study show a clear correlation between Wells criteria score risk levels with an increased predictive likelihood of a positive PE. Dyspnea and chest pain proved to be the most frequent clinical findings outside wells criteria. The age-adjusted D-dimer in this study data demonstrated to be a candidate for further evaluation with great potential for clinical application. Electrocardiogram S1Q3T3 findings displayed a specificity of 92,86% and positive predictive value 69,70%. The conclusion of this study reveals that a standardized approach that includes Wells criteria together with an age-adjusted D-dimer may avoid unnecessary steps and examinations in diagnosis of PE, namely that of D-dimer tests and CTPA.

KEYWORDS
Pulmonary Embolism, Thromboembolism, DVT, Wells, D-dimer, Electrocardiogram, Angiography

Cite This Paper in IEEE or APA Citation Styles
(a). IEEE Format:
[1] Bruno Sousa Dos Santos , Maya Wielert , Ieva Krieva , Kathryn Mullan , Sandra Seimane , Aleksejs Visnakovs , Olegs Sabelnikovs , "Acute Pulmonary Thromboembolism Retrospective Auditory - The Benefits of Clinical Predictive Tools," Universal Journal of Public Health, Vol. 7, No. 1, pp. 19 - 29, 2019. DOI: 10.13189/ujph.2019.070103.

(b). APA Format:
Bruno Sousa Dos Santos , Maya Wielert , Ieva Krieva , Kathryn Mullan , Sandra Seimane , Aleksejs Visnakovs , Olegs Sabelnikovs (2019). Acute Pulmonary Thromboembolism Retrospective Auditory - The Benefits of Clinical Predictive Tools. Universal Journal of Public Health, 7(1), 19 - 29. DOI: 10.13189/ujph.2019.070103.