[ + ]
Abnormal Cardiac Exam
+
0
-
22% 88%
including: increased P2, right ventricular lift, or JVD
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
Abnormal Lung Exam
+
0
-
37% 64%
including: crackles, wheezes, friction rub, etc
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
Arterial Blood Gas
+
0
-
84.2% 27.4%
increased A-a gradient
Study: Am J Respir Crit Care Med. 2000 Dec;162(6):2105-8. PMID: 11112122
[ + ]
Arterial Blood Gas
+
0
-
91.9% 14.7%
increased A-a gradient OR PaCO2 < 36
Study: Am J Respir Crit Care Med. 2000 Dec;162(6):2105-8. PMID: 11112122
[ + ]
Arterial Blood Gas or History of DVT
+
0
-
92.1% 21.1%
increased A-a gradient OR history of DVT/PE
Study: Am J Respir Crit Care Med. 2000 Dec;162(6):2105-8. PMID: 11112122
[ + ]
Arterial Oxygen or History of DVT
+
0
-
91.9% 32.4%
PaO2 < 80 OR history of DVT/PE
Study: Am J Respir Crit Care Med. 2000 Dec;162(6):2105-8. PMID: 11112122
[ + ]
Arterial Oxygen, D-dimer, or Respiratory Rate
+
0
-
96.9% 21.3%
PaO2 < 80, positive D-dimer, OR resp rate > 20
Study: Am J Respir Crit Care Med. 2000 Dec;162(6):2105-8. PMID: 11112122
[ + ]
Calf or Thigh Pain
+
0
-
42% 75%
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
Calf or Thigh Swelling
+
0
-
39% 80%
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
Chest Pain
+
0
-
17% 79%
non-pleuritic
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
CT angiography
+
0
-
90% 95%
multi-detector CT with CT venography
Study: PIOPED II (NEJM 2006;354: 2317)
[ + ]
Doppler Ultrasound
+
0
-
29% 97%
for PE
Study: Ann Intern Med. 1997 May 15;126(10):775-81. PMID: 9148650
[ + ]
Dyspnea
+
0
-
36% 74%
dyspnea as the only presenting symptom
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
ECG
Sensitivity = 86.5%
any abnormality
pooled from reproduced data (91% in this particular case series)
Study: Chest. 1997 Mar;111(3):537-43. PMID: 9118684
[ + ]
Elevated D-dimer
+
0
-
95% 25%
positive is generally >500ng/ml
In another study, D-dimer had 83% sensitivity and 58% specificity (PMID 11112122 )
Study: Ann Intern Med 2004 Apr 20;140(8):589-602. PMID: 15096330
Am J Respir Crit Care Med 1999; 160:1043.
[ + ]
Homan's Sign
+
0
-
33% 79%
for DVT by venography.
See http://www.turner-white.com/pdf/hp_mar01_homan.pdf for a full description. Briefly: "The patient’s knee should be in the flexed position. The examiner should forcibly and abruptly dorsiflex the patient’s ankle and observe for pain in the calf and popliteal region, which constitutes a positive sign".
Study: Angiology. 1969 Apr;20(4):219-23. PMID 5778113
[ + ]
Leg US
+
0
-
93% 98%
for DVT by venography. this is "duplex ultrasound".
Study: Ann Intern Med. 1989 Aug 15;111(4):297-304. PMID 2667418
[ + ]
Low ECG Voltage
Sensitivity = 29%
Study: Chest. 1997 Mar;111(3):537-43. PMID: 9118684
[ + ]
MRA and MRV
+
0
-
92% 96%
BUT 52% of patients had technically inadequate results
MRA alone had sens = 78% / spec = 99% and was technically inadequate in 25% of patients
Study: PIOPED III Ann Int Med 2010 v152(7): 434 http://www.annals.org/content/152/7/434.abstract?etoc
[ + ]
No Typical Symptoms
+
0
-
12% 87%
no chest pain / hemoptysis / dyspnea as the presenting symptoms
presentations were: tachycardia/tachypnea + signs/sxs of DVT, or hypoxemia, or other presentation
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
Pleuritic Chest Pain
+
0
-
47% 41%
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
Pleuritic Chest Pain or Hemoptysis
+
0
-
44% 44%
all comers. slightly lower rate in patients with PE but no prior cardiopulmonary disease
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
pro BNP
+
0
-
60% 62%
>1.25pmol/L
Study: J Thromb Haemost. 2006 Mar;4(3):552-6. Epub 2005 Dec 23. PMID 16405522
[ + ]
Right Bundle Branch Block
Sensitivity = 22%
Study: Chest. 1997 Mar;111(3):537-43. PMID: 9118684
[ + ]
S1 Q3 T3 Pattern
Sensitivity = 27.5%
S wave in I, Q wave in III, and inverted T in III
pooled from reproduced data - sensitivity ranges 12-50% in different series
Interestingly, despite the classical description of this feature as representing right heart strain, it was not predictive of massive PE in this case series.
Study: Chest. 1997 Mar;111(3):537-43. PMID: 9118684
[ + ]
Signs of DVT
+
0
-
47% 77%
in calf or thigh: edema, erythema, tenderness, or palpable cord
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
T-Wave Inversion
Sensitivity = 49%
anterior leads V1-V4
pooled from reproduced data - sensitivity ranges 42-89%; in this study it was the most prevalent ECG sign
Study: Chest. 1997 Mar;111(3):537-43. PMID: 9118684
[ + ]
Tachycardia
Sensitivity = 60%
pooled from reproduced data - sensitivity = 36-90% depending on the case series. In this particular case series, it was not the most prevalent ECG finding; rather, T wave inversion was. In one other series, it was 90% prevalent (equivalent to TWI), and in PMID 123074 , it is the most prevalent at 69% while TWI is only 42%.
In this study, it was only present in 'massive' PE (defined by clot burden on PA cath).
Study: Chest. 1997 Mar;111(3):537-43. PMID: 9118684
[ + ]
Tachypnea
+
0
-
57% 53%
RR > 20
Study: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458
[ + ]
V/Q scan
+
0
-
77% 98%
about 25% of patients had an indeterminate scan and were excluded from this analysis.
Study: Re-analysis of PIOPED II: Radiology. 2008 Mar;246(3):941-6. PMID: 18195380