Morris Nicole F, Georgie Rasha, D'Arsigny Christine L, James Paula, Parpia Sameer, Germini Federico, Clayton Natasha, Good David, de Wit Kerstin
Medicine, Queen's University, Kingston, Ontario, Canada
Emergency Medicine, Queen's University, Kingston, Ontario, Canada.
Emerg Med J. 2025 Jul 22;42(8):496-502. doi: 10.1136/emermed-2024-214465.
Studies on pulmonary embolism (PE) rule-out strategies traditionally recruited patients in the ED. This method is increasingly impractical given excessive pressures experienced in EDs. Attempting to reach patients after leaving the ED may be more feasible. The aim of this study was to assess the feasibility of recruiting and following patients for an ED PE testing study by telephone.
This was a prospective pilot study conducted in one ED and one urgent care centre in Ontario, Canada. Adult patients tested for PE using Adjust-Unlikely (a simple decision rule combining Gestalt with age-adjusted D-dimer) were called for consent after leaving the ED. Patients were followed for 90 days by medical record review plus telephone, text or email to identify subsequent venous thromboembolism testing. Venous thromboembolism events were independently adjudicated. Feasibility outcomes were recruitment rate, missed eligible rate and follow-up rate. Progression criteria were a recruitment rate of at least five participants per site, per week, a missed eligible rate of no more than two patients per site, per week, and a follow-up rate of at least 90% of enrolled patients.
684 patients were tested for PE between 24 March and 10 June 2023. A total of 210 patients were excluded. From 474 eligible patients, 200 were recruited. Median age was 58 years, 72.2% were female, and 3.5% were diagnosed with PE on index visit. Median recruitment rate was 7 participants per site, per week (first-third quartile (Q1-Q3), 4-14) and median missed eligible rate was 6 patients per site, per week (Q1-Q3, 3-8). After 90 days, 2 participants withdrew and 191/198 (96.5%, 95% CI 92.9, 98.3%) were contacted in follow-up. 143/198 (72.2%, 95% CI 65.6, 78.0%) participants did not require pulmonary imaging because PE was excluded by Adjust-Unlikely. 1/143 (0.7%, 95% CI 0.1, 3.9%) of these participants was diagnosed with PE in the segmental pulmonary arteries during follow-up.
Telephone recruitment did not meet predefined feasibility thresholds as the missed eligible rate was high. However, the recruitment rate was higher than in previous studies, and there was minimal loss to follow-up.
关于肺栓塞（PE）排除策略的研究传统上是在急诊科招募患者。鉴于急诊科面临的巨大压力，这种方法越来越不切实际。在患者离开急诊科后试图联系他们可能更可行。本研究的目的是评估通过电话招募和随访患者进行急诊科PE检测研究的可行性。
这是一项在加拿大安大略省的一个急诊科和一个紧急护理中心进行的前瞻性试点研究。使用Adjust-Unlikely（一种将整体判断与年龄调整后的D-二聚体相结合的简单决策规则）进行PE检测的成年患者在离开急诊科后被电话联系以获取同意。通过病历审查以及电话、短信或电子邮件对患者进行90天的随访，以确定随后的静脉血栓栓塞检测情况。静脉血栓栓塞事件由独立判定。可行性结果包括招募率、错过符合条件患者率和随访率。进展标准为每个站点每周至少招募5名参与者，每个站点每周错过符合条件患者率不超过2名，以及至少90%的入组患者的随访率。
2023年3月24日至6月10日期间，684例患者接受了PE检测。总共排除210例患者。从474例符合条件的患者中，招募了200例。中位年龄为58岁，72.2%为女性，3.5%在首次就诊时被诊断为PE。中位招募率为每个站点每周7名参与者（第一至第三四分位数（Q1-Q3），4-14），中位错过符合条件患者率为每个站点每周6例患者（Q1-Q3，3-8）。90天后，2名参与者退出，198例中有191例（96.5%，95%CI 92.9，98.3%）在随访中被联系。198例中有143例（72.2%，95%CI 65.6，78.0%）参与者不需要肺部成像，因为Adjust-Unlikely排除了PE。这些参与者中有1/143（0.7%，95%CI 0.1，3.9%）在随访期间被诊断为节段性肺动脉PE。
由于错过符合条件患者率较高，电话招募未达到预定义的可行性阈值。然而，招募率高于以往研究，随访失访率极低。
