Home > Uncategorized > Pulmonary Embolism and First Syncope Presentation

Pulmonary Embolism and First Syncope Presentation

Prandoni et al report an Italian multi-centre trial of systematic investigation for pulmonary embolism in patients with first presentation of syncope. The prevalence of pulmonary embolism including cases with alternative diagnoses is highlighted.

Abstract

BACKGROUND

The prevalence of pulmonary embolism among patients hospitalized for syncope
is not well documented, and current guidelines pay little attention to a diagnostic workup for pulmonary embolism in these patients.

METHODS

We performed a systematic workup for pulmonary embolism in patients admitted
to 11 hospitals in Italy for a first episode of syncope, regardless of whether there were alternative explanations for the syncope. The diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability, which was defined according to the Wells score, in combination with a negative d-dimer assay. In all other patients, computed tomographic pulmonary angiography or ventilation–perfusion lung scanning was performed.

RESULTS

A total of 560 patients (mean age, 76 years) were included in the study. A diagnosis of pulmonary embolism was ruled out in 330 of the 560 patients (58.9%) on the basis of the combination of a low pretest clinical probability of pulmonary embolism and negative d-dimer assay. Among the remaining 230 patients, pulmonary embolism was identified in 97 (42.2%). In the entire cohort, the prevalence of pulmonary embolism was 17.3% (95% confidence interval, 14.2 to 20.5). Evidence of an embolus in a main pulmonary or lobar artery or evidence of perfusion defects larger than 25% of the total area of both lungs was found in 61 patients. Pulmonary embolism was identified in 45 of the 355 patients (12.7%) who had an alternative explanation for syncope and in 52 of the 205 patients (25.4%) who did not.

CONCLUSIONS

Pulmonary embolism was identified in nearly one of every six patients hospitalized for a first episode of syncope.

Advertisements
Categories: Uncategorized
  1. No comments yet.
  1. No trackbacks yet.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: