Pourmand Ali, Robinson Hannah, Mazer-Amirshahi Maryann, Pines Jesse M
Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, District of Columbia.
J Emerg Med. 2018 Sep;55(3):339-346. doi: 10.1016/j.jemermed.2018.05.026. Epub 2018 Jun 23.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Common in COPD are acute exacerbations (AE-COPD) that cause acute dyspnea, cough, and bronchospasm. Symptoms of AE-COPD mimic pulmonary embolism (PE).
We conducted a systematic review of the literature to assess the prevalence of PE in patients admitted to the hospital with a clinical diagnosis of AE-COPD. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we queried PubMed and MEDLINE databases from 1990 to 2017. The search term "prevalence pulmonary embolism, COPD" was used, and Boolean operators were used to combine search terms. Data were extracted from each article, specifically the sample size, study setting, design, and the prevalence of PE.
A total of 5 articles were included that demonstrated a prevalence of PE among patients with a clinical diagnosis of AE-COPD that ranged from 3.3-29.1%. Sample sizes varied from 49-197 patients. Studies occurred in both emergency department and inpatient settings, including intensive care units. Among the studies that reported patient characteristics associated with PE in AE-COPD, both obesity and immobility were important.
Studies reporting the prevalence of PE during AE-COPD vary considerably in their methods and results. Because of the relatively high prevalence of PE during AE-COPD, it is important for providers to be aware of this linkage between the 2 conditions and to screen patients using clinical gestalt and validated screening tools until more emergency department data are available.
慢性阻塞性肺疾病（COPD）是全球发病和死亡的主要原因。慢性阻塞性肺疾病急性加重（AE-COPD）很常见，可导致急性呼吸困难、咳嗽和支气管痉挛。AE-COPD的症状与肺栓塞（PE）相似。
我们对文献进行了系统综述，以评估临床诊断为AE-COPD并入院的患者中PE的患病率。按照系统评价和Meta分析的首选报告项目指南，我们查询了1990年至2017年的PubMed和MEDLINE数据库。使用搜索词“肺栓塞患病率，COPD”，并使用布尔运算符组合搜索词。从每篇文章中提取数据，特别是样本量、研究背景、设计和PE的患病率。
共纳入5篇文章，这些文章显示临床诊断为AE-COPD的患者中PE的患病率在3.3%-29.1%之间。样本量从49例至197例患者不等。研究在急诊科和住院部进行，包括重症监护病房。在报告AE-COPD中与PE相关的患者特征的研究中，肥胖和活动减少均很重要。
报告AE-COPD期间PE患病率的研究在方法和结果上差异很大。由于AE-COPD期间PE的患病率相对较高，在有更多急诊科数据之前，医疗服务提供者了解这两种疾病之间的联系并使用临床经验和经过验证的筛查工具对患者进行筛查很重要。
