Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
Emergency Department, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, INSERM U942-MASCOT, Bobigny, France.
Acad Emerg Med. 2022 Oct;29(10):1205-1212. doi: 10.1111/acem.14574. Epub 2022 Aug 17.
Hemoptysis is not common in pulmonary embolism (PE) and lacks specificity for its diagnosis. However, this item is present in different validated scores that estimate the clinical probability of PE. The relevance of this item in clinical decision rules (CDRs) is not clearly established.
The aim of this study was to evaluate the impact of removing the "hemoptysis" item from the PERC, YEARS, and PEGeD CDR in patients with low clinical probability of PE.
This was a post hoc analysis of two European prospective cohorts, which included 2968 patients presenting to the ED with a low clinical probability of PE (PROPER and PERCEPIC) and a 3-month follow-up. The primary endpoint was the false-negative rate of a CDR score without the hemoptysis item. Secondary endpoints included the potential reduction of chest imaging if the item hemoptysis was to be removed and risk stratification of the Geneva and Wells scores without the hemoptysis item.
Of 2968 patients included (mean ± SD age 46 ± 18 years, 53% female), 87 patients (3%) had a PE diagnosed at 3 months. A total of 2908 were followed-up at 3 months and analyzed. Using the PERC rule with and without the hemoptysis item, there were 13 and 14 missed cases of PE, respectively (failure rate 0.45% [95% CI 0.25%-0.78%] and 0.48% [95% CI 0.27%-0.82%]). Using the YEARS strategy, there were 11 missed PE cases with or without the hemoptysis item (false-negative rate 0.57% [95% CI 0.30%-1.05%]). With the PERC and YEARS rule, removing the hemoptysis item would have led to a 1% reduction in chest imaging. The PEGeD strategy was not modified by the removal of the hemoptysis item.
The hemoptysis item could be safely removed from the PERC, YEARS, and PEGeD CDRs. However, there was no subsequent clinically relevant reduction of chest imaging.
咯血并不常见于肺栓塞（PE），并且对其诊断缺乏特异性。然而，不同经过验证的评分系统均包含了这一项目，用于评估 PE 的临床可能性。目前，尚不清楚这一项目在临床决策规则（CDR）中的相关性。
本研究旨在评估在临床低度疑似 PE 患者中，从 PERC、YEARS 和 PEGeD CDR 中删除“咯血”项目对其的影响。
这是两项欧洲前瞻性队列研究的事后分析，共纳入了 2968 例因临床低度疑似 PE 而就诊于急诊科的患者（PROPER 和 PERCEPIC），并进行了 3 个月的随访。主要终点是 CDR 评分中不包含咯血项目时的假阴性率。次要终点包括如果删除咯血项目，胸部影像学检查的潜在减少，以及不包含咯血项目时，日内瓦和 Wells 评分的风险分层。
共纳入 2968 例患者（平均年龄 46±18 岁，53%为女性），其中 87 例（3%）在 3 个月时被诊断为 PE。共有 2908 例患者在 3 个月时进行了随访和分析。在 PERC 规则中，包含和不包含咯血项目时，分别有 13 例和 14 例漏诊的 PE（失败率为 0.45%[95%CI 0.25%-0.78%]和 0.48%[95%CI 0.27%-0.82%]）。在 YEARS 策略中，包含和不包含咯血项目时，分别有 11 例漏诊的 PE（假阴性率为 0.57%[95%CI 0.30%-1.05%]）。在 PERC 和 YEARS 规则中，删除咯血项目可使胸部影像学检查减少 1%。PEGeD 策略不受删除咯血项目的影响。
PERC、YEARS 和 PEGeD CDR 可安全地删除咯血项目。然而，这并不会对胸部影像学检查产生后续的临床相关减少。
