McDonald A H, Murphy R
Department of Emergency Medicine, Royal Infirmary of Edinburgh, UK.
J R Coll Physicians Edinb. 2011 Sep;41(3):196-201. doi: 10.4997/JRCPE.2011.302.
Patients with possible pulmonary embolism (PE) commonly present to acute medical services. Research has led to the identification of low-risk patients suitable for ambulatory management. We report on a protocol designed to select low-risk patients for ambulatory investigation if confirmatory imaging is not available that day.
The protocol was piloted in the Emergency Department and Medical Assessment Area at the Royal Infirmary of Edinburgh. We retrospectively analysed electronic patient records in an open observational audit of all patients managed in the ambulatory arm over five months of use.
We analysed 45 patients' records. Of these, 91.1% required imaging to confirm or refute PE, 62.2% received a computed tomography pulmonary angiogram (CTPA). In 25% of patients, PE was confirmed with musculoskeletal pain (22.7%), and respiratory tract infection (15.9%) the next most prevalent diagnoses. Alternative diagnoses was provided by CTPA in 32% of cases. We identified no adverse events or readmissions but individualised follow-up was not attempted.
The data from this audit suggests this protocol can be applied to select and manage low-risk patients suitable for ambulatory investigation of possible PE. A larger prospective comparative study would be required to accurately define the safety and effectiveness of this protocol.
疑似肺栓塞（PE）的患者通常会前往急诊医疗服务机构就诊。研究已确定了适合门诊管理的低风险患者。我们报告了一项旨在选择低风险患者进行门诊检查的方案，前提是当天无法进行确诊性影像学检查。
该方案在爱丁堡皇家医院急诊科和医学评估区进行了试点。我们对使用该方案五个月期间门诊治疗的所有患者进行了开放式观察性审计，回顾性分析了电子病历。
我们分析了45例患者的记录。其中，91.1%的患者需要影像学检查来确诊或排除PE，62.2%的患者接受了计算机断层扫描肺动脉造影（CTPA）。25%的患者确诊为PE，最常见的其他诊断为肌肉骨骼疼痛（22.7%）和呼吸道感染（15.9%）。CTPA在32%的病例中提供了其他诊断。我们未发现不良事件或再次入院情况，但未尝试进行个体化随访。
本次审计的数据表明，该方案可用于选择和管理适合对疑似PE进行门诊检查的低风险患者。需要进行更大规模的前瞻性比较研究，以准确界定该方案的安全性和有效性。
