Russell J B W, Baio S, Koroma T R, Conteh V, Conteh S, Smith M, Bharat K, Coker J M, Gordon-Harris L, Lisk D R
Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone.
Choithrams Memorial Hospital, Sierra Leone.
West Afr J Med. 2022 Oct 20;39(10):997-1006.
In Sierra Leone, the lack of information on pulmonary embolism (PE) limits the access to evidence-based standard of diagnostic work-up and management of the disease. The objective of this study was to describe the clinical characteristics and management of acute pulmonary embolism in our setting and to determine whether the pre-test probability scoring algorithms were used prior to Computed Tomography Pulmonary Angiogram (CTPA) request.
This retrospective observational study was conducted on CTPA-confirmed PE patients admitted to the Intensive Care Unit, Choithrams Memorial Hospital, in Freetown, Sierra Leone between July 2014 to June 2019. Clinical data, and pertinent investigations related to PE were determined. CTPA findings were correlated with the patient's hemodynamic status. The calculated pretest clinical probability scores (PCPS) for each patient were compared to the CTPA results.
CTPA-confirmed PE in the study cohort was 79, with a rate of 16 new PE per year. The frequency of PE was 1.9% of the total hospital admission per year. The mean age was 64.1 ± 17.9 years, median age was 63.3years (range: 23-89 years), with 55.7% of the cohort being females. Dyspnea (78.5%) and tachycardia (69.6%) were the commonest signs and symptoms documented, with immobilization (34.2%) being the prevalent risk factor, while hypertension (48.1%) was the most common co-morbidity. The PCPS algorithm was underutilized, as "Wells Score" was documented in only 9.5% while "modified Geneva score" was never used by hospital physicians. PE with hemodynamic stability was significantly more common than PE with unstable hemodynamic status [55 (69.6%) vs 24 (30.4%), p=0.015]. All patients were managed only with anticoagulants. The overall in-hospital mortality was 17.7%.
Since PCPS was hardly calculated by doctors in the diagnosis of PE, the study showed that the diagnostic algorithm for suspected PE was infrequently used in clinical practice. The use of empirical judgement by doctors in requesting for CTPA may have accounted for low rate in the diagnosis of PE per year. The establishment of P.E registry in Sierra Leone is imperative.
在塞拉利昂，缺乏关于肺栓塞（PE）的信息限制了获得基于证据的疾病诊断检查和管理标准的途径。本研究的目的是描述我们所研究环境中急性肺栓塞的临床特征和管理情况，并确定在请求进行计算机断层扫描肺动脉造影（CTPA）之前是否使用了预测试概率评分算法。
这项回顾性观察研究针对2014年7月至2019年6月期间在塞拉利昂弗里敦乔伊斯拉姆斯纪念医院重症监护病房收治的CTPA确诊的PE患者进行。确定了与PE相关的临床数据和相关检查。将CTPA结果与患者的血流动力学状态相关联。将每位患者计算出的预测试临床概率评分（PCPS）与CTPA结果进行比较。
研究队列中CTPA确诊的PE患者有79例，每年有16例新的PE病例。PE的发生率为每年总住院人数的1.9%。平均年龄为64.1±17.9岁，中位年龄为63.3岁（范围：23 - 89岁），队列中55.7%为女性。记录到的最常见体征和症状是呼吸困难（78.5%）和心动过速（69.6%），制动（34.2%）是主要危险因素，而高血压（48.1%）是最常见的合并症。PCPS算法未得到充分利用，因为仅9.5%的病例记录了“Wells评分”，而医院医生从未使用过“改良日内瓦评分”。血流动力学稳定的PE比血流动力学不稳定的PE明显更常见[55例（69.6%）对24例（30.4%），p = 0.015]。所有患者仅接受抗凝治疗。总体住院死亡率为17.7%。
由于医生在诊断PE时几乎不计算PCPS，该研究表明疑似PE的诊断算法在临床实践中很少使用。医生在请求进行CTPA时使用经验判断可能是每年PE诊断率低的原因。在塞拉利昂建立PE登记册势在必行。
