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Episode 11 - Pulmonary Embolism: Part 3 - YEARS Algorithm
Manage episode 315588698 series 2912105
Theme:
Pulmonary Embolism.
Participants:
Dr Bristi Roy (respiratory physician), Dr Vanessa Wong (respiratory advanced trainee), Dr Arwen Morath (emergency physician), Dr Pramod Chandru, Kit Rowe, and Caroline Tyers.
Discussion:
van der Pol, L., Tromeur, C., Bistervels, I., Ni Ainle, F., van Bemmel, T., & Bertoletti, L. et al. (2019). Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. New England Journal Of Medicine, 380(12), 1139-1149. https://doi.org/10.1056/nejmoa1813865.
Presenter:
Dr Vanessa Wong (respiratory advanced trainee at Westmead Hospital).
Summary:
- PE is a leading cause of maternal death in pregnant women.
- However, the radiation exposure to both mother and foetus involved in the diagnosis of PE remains a complex issue.
- This is a multi-centre prospective study that utilised the YEARS algorithm (published several years prior) and a D-dimer to predict PE in pregnant women presenting with suspected PE.
- The study was conducted over a 5-year period from October 2013 to May 2019.
- It looked at pregnant women over the age of 18 years that had been referred to ED or the obstetric ward with concerns for potential PE.
- The YEARS algorithm focuses on the 3 elements of the Well’s criteria considered to be the highest yield (being clinical signs of DVT, haemoptysis, and PE as the most likely diagnosis).
- As part of the algorithm, those patients with clinical signs of DVT underwent a doppler US and were commenced on anticoagulation (and presumed to have a PE) if this was positive for DVT.
- PE was excluded in those patients without any of the YEARS criteria and with a D-dimer less than 1.0.
- PE was also excluded in those who had 1-3 of the YEARS criteria and a D-dimer < 0.5, while those with 1-3 of the YEARS criteria and a D-dimer > 0.5 went on to have a CTPA to look for PE.
- The primary outcome was the cumulative incidence of symptomatic VTE on objective testing during a 3 month follow-up period.
- The secondary outcome was the proportion of patients in whom CTPA was not indicated to safely exclude PE.
- There were 510 pregnant women recruited into the study (46% of whom were in the third trimester of pregnancy) with 12 being excluded
- Of the 498 patients included, 4 had signs and symptoms of DVT with a positive doppler ultrasound.
- 20 patients of the remaining 494 were diagnosed with PE as part of the pathway.
- During follow-up, one popliteal DVT was diagnosed, and no patient had PE.
- CTPA was avoided in 195 patients (39%).
Take-Home Points:
- This provides a framework for assessing patients, particularly in the first and second trimesters of pregnancy (and may aid in safely excluding PE without CTPA for low-risk patients).
- However, in high-risk patients, pursuing a scan remains the most appropriate approach.
References:
- van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390:289-297.
Credits:
This episode was produced by the Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta.
Music/Sound Effects
- Dusk by MusicbyAden | https://soundcloud.com/musicbyaden, Music promoted by https://www.free-stock-music.com
Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. - It’s Time by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.com
Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. - Magic by Savfk | https://www.youtube.com/savfkmusic, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.
- My Old East Coast by Vendredi feat. Melanie | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.
- Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.
- Sound effects from https://www.free-stock-music.com.
- Tropical Fever by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.
Thank you for listening!
Please send us an email to let us know what you thought.
You can contact us at westmeadedjournalclub@gmail.com.
You can also follow us on Facebook, Instagram, and Twitter!
See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.
~
65 episódios
Manage episode 315588698 series 2912105
Theme:
Pulmonary Embolism.
Participants:
Dr Bristi Roy (respiratory physician), Dr Vanessa Wong (respiratory advanced trainee), Dr Arwen Morath (emergency physician), Dr Pramod Chandru, Kit Rowe, and Caroline Tyers.
Discussion:
van der Pol, L., Tromeur, C., Bistervels, I., Ni Ainle, F., van Bemmel, T., & Bertoletti, L. et al. (2019). Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. New England Journal Of Medicine, 380(12), 1139-1149. https://doi.org/10.1056/nejmoa1813865.
Presenter:
Dr Vanessa Wong (respiratory advanced trainee at Westmead Hospital).
Summary:
- PE is a leading cause of maternal death in pregnant women.
- However, the radiation exposure to both mother and foetus involved in the diagnosis of PE remains a complex issue.
- This is a multi-centre prospective study that utilised the YEARS algorithm (published several years prior) and a D-dimer to predict PE in pregnant women presenting with suspected PE.
- The study was conducted over a 5-year period from October 2013 to May 2019.
- It looked at pregnant women over the age of 18 years that had been referred to ED or the obstetric ward with concerns for potential PE.
- The YEARS algorithm focuses on the 3 elements of the Well’s criteria considered to be the highest yield (being clinical signs of DVT, haemoptysis, and PE as the most likely diagnosis).
- As part of the algorithm, those patients with clinical signs of DVT underwent a doppler US and were commenced on anticoagulation (and presumed to have a PE) if this was positive for DVT.
- PE was excluded in those patients without any of the YEARS criteria and with a D-dimer less than 1.0.
- PE was also excluded in those who had 1-3 of the YEARS criteria and a D-dimer < 0.5, while those with 1-3 of the YEARS criteria and a D-dimer > 0.5 went on to have a CTPA to look for PE.
- The primary outcome was the cumulative incidence of symptomatic VTE on objective testing during a 3 month follow-up period.
- The secondary outcome was the proportion of patients in whom CTPA was not indicated to safely exclude PE.
- There were 510 pregnant women recruited into the study (46% of whom were in the third trimester of pregnancy) with 12 being excluded
- Of the 498 patients included, 4 had signs and symptoms of DVT with a positive doppler ultrasound.
- 20 patients of the remaining 494 were diagnosed with PE as part of the pathway.
- During follow-up, one popliteal DVT was diagnosed, and no patient had PE.
- CTPA was avoided in 195 patients (39%).
Take-Home Points:
- This provides a framework for assessing patients, particularly in the first and second trimesters of pregnancy (and may aid in safely excluding PE without CTPA for low-risk patients).
- However, in high-risk patients, pursuing a scan remains the most appropriate approach.
References:
- van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390:289-297.
Credits:
This episode was produced by the Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta.
Music/Sound Effects
- Dusk by MusicbyAden | https://soundcloud.com/musicbyaden, Music promoted by https://www.free-stock-music.com
Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. - It’s Time by Jay Someday | https://soundcloud.com/jaysomeday, Music promoted by https://www.free-stock-music.com
Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. - Magic by Savfk | https://www.youtube.com/savfkmusic, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.
- My Old East Coast by Vendredi feat. Melanie | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.
- Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.
- Sound effects from https://www.free-stock-music.com.
- Tropical Fever by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.
Thank you for listening!
Please send us an email to let us know what you thought.
You can contact us at westmeadedjournalclub@gmail.com.
You can also follow us on Facebook, Instagram, and Twitter!
See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.
~
65 episódios
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