Germini Federico, Zarabi Sahar, Eventov Michelle, Turcotte Michelle, Li Meirui, de Wit Kerstin
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada.
J Thromb Haemost. 2021 Jan;19(1):173-185. doi: 10.1111/jth.15124. Epub 2020 Nov 18.
Essentials The threshold to test for pulmonary embolism (PE) might be lower in North America than Europe. We compared the PE prevalence and positive yield of imaging in Europe and North America. More patients tested in Europe are diagnosed with PE, and imaging is more often positive. Our systematic review supports the hypothesis of overtesting for PE in North America. ABSTRACT: Background There is an impression that North American emergency department (ED) patients tested for pulmonary embolism (PE) differ from European ones. Objectives We compared the PE prevalence, frequency of use, and positive yield of imaging among ED patients tested for PE in Europe and North America. Methods We searched for studies reporting consecutive ED patients tested for PE. Two authors screened full texts, performed risk of bias assessment, and data extraction. We conducted a meta-analysis of proportions for each outcome and a multiple meta-regression. Results From 3109 publications, 44 were included in the systematic review. The prevalence of PE in Europe was 23% (95% confidence interval [CI], 21-26) and in North America 8% (95% CI, 6-9). The adjusted mean difference (aMD) in the prevalence of PE in the European compared with North American studies, was 15% (95% CI, 10-20). Computed tomography pulmonary angiography (CTPA) was used in 60% (95% CI, 52%-68) of European and 38% (95% CI, 24-51) of North American patients tested for PE (aMD, 23% [95% CI, 7-39]). The CTPA diagnostic yield was 29% (95% CI, 26-32) in Europe and 13% (95% CI, 9-17) in North America (aMD, 15% [95% CI, 8-21]). Conclusion Compared with North America, European ED studies have a higher prevalence of PE and diagnostic yield from CTPA, despite a higher frequency of CTPA use among patients tested for PE. This supports the hypothesis that those tested for PE in North American EDs have a lower risk of PE compared with Europe.
在北美，检测肺栓塞（PE）的阈值可能低于欧洲。我们比较了欧洲和北美PE的患病率以及影像学检查的阳性率。在欧洲接受检测的患者中，被诊断为PE的更多，且影像学检查更常呈阳性。我们的系统评价支持北美存在对PE过度检测的假设。
背景 有一种观点认为，在北美急诊科（ED）接受肺栓塞（PE）检测的患者与欧洲患者不同。目的 我们比较了欧洲和北美急诊科接受PE检测的患者中PE的患病率、检查使用频率及影像学检查的阳性率。方法 我们检索了报告连续的接受PE检测的ED患者的研究。两位作者筛选全文，进行偏倚风险评估并提取数据。我们对每个结果进行了比例的Meta分析和多元Meta回归。结果 从3109篇出版物中，44篇被纳入系统评价。欧洲PE的患病率为23%（95%置信区间[CI]，21 - 26），北美为8%（95%CI，6 - 9）。与北美研究相比，欧洲研究中PE患病率的调整后平均差异（aMD）为15%（95%CI，10 - 20）。在接受PE检测的欧洲患者中，60%（95%CI，52% - 68%）使用了计算机断层扫描肺动脉造影（CTPA），北美患者中这一比例为38%（95%CI，24 - 51）（aMD，23%[95%CI，7 - 39]）。CTPA的诊断率在欧洲为29%（95%CI，26 - 32），在北美为13%（95%CI，9 - 17）（aMD，15%[95%CI，8 - 21]）。结论 与北美相比，欧洲急诊科的研究中PE患病率更高，CTPA的诊断率也更高，尽管在接受PE检测的患者中CTPA的使用频率更高。这支持了以下假设：与欧洲相比，在北美急诊科接受PE检测的患者发生PE的风险更低。
