Age and sex-dependent trends in pulmonary embolism testing and derivation of a clinical decision rule for young patients

Emergency Medicine Journal : EMJ
John MonganRebecca Smith-Bindman

Abstract

Despite low prevalence of pulmonary embolism (PE) in young adults, they are frequently imaged for PE, which involves radiation exposure and substantial financial cost. Determine the use and positive proportions for PE imaging by age, differences in clinical presentation of PE by age and the projected impact of an age-targeted decision rule. Analysis of two national population-based datasets: the 2009 Nationwide Emergency Department Sample, a 20% sample of US emergency departments (EDs) and the 2003-2006 Pulmonary Embolism Rule-out Criteria (PERC) dataset, a multisite cohort of ED patients with suspected PE from 12 US EDs. Prevalence of PE was 10 times lower in young patients (18-35 years) than in older patients (>65 years) (0.06% vs 0.60%, p<0.001), but young patients were imaged for PE almost as frequently as older patients (2.3% vs 3.2%). This resulted in a lower proportion of positive examinations in young adults than older adults (2.3% vs 17.4%, p<0.001 in women; 4.0% vs 21.4%, p<0.001 in men). Clinical predictors of PE varied by age. Tachycardia was a significant predictor of PE in older patients (OR: 1.2-1.9, p<0.001), but not young patients. Fever was a significant predictor only in young patients (OR: 1.4-7.2, p<0.01). ...Continue Reading

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Citations

Dec 14, 2016·AJR. American Journal of Roentgenology·William M Sherk, Jadranka Stojanovska
Oct 28, 2017·Canadian Association of Radiologists Journal = Journal L'Association Canadienne Des Radiologistes·Mehran MidiaJeff Muir
Jan 8, 2020·Postgraduate Medical Journal·Tanya AggarwalPrashant Nagpal
Feb 4, 2021·Journal of the American College of Emergency Physicians Open·Angela F JarmanBrandon C Maughan
Jan 27, 2021·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Justin J ReaghGregory J Fermann

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