Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?

Details

Serval ID
serval:BIB_E4D92D3D2221
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?
Journal
Thorax
Author(s)
Rutschmann O.T., Cornuz J., Poletti P.A., Bridevaux P.O., Hugli O.W., Qanadli S.D., Perrier A.
ISSN
0040-6376
Publication state
Published
Issued date
2007
Peer-reviewed
Oui
Volume
62
Number
2
Pages
121-125
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't - Publication Status: ppublish
Abstract
BACKGROUND: The cause of acute exacerbation of chronic obstructive pulmonary disease (COPD) is often difficult to determine. Pulmonary embolism may be a trigger of acute dyspnoea in patients with COPD. AIM: To determine the prevalence of pulmonary embolism in patients with acute exacerbation of COPD. METHODS: 123 consecutive patients admitted to the emergency departments of two academic teaching hospitals for acute exacerbation of moderate to very severe COPD were included. Pulmonary embolism was investigated in all patients (whether or not clinically suspected) following a standardised algorithm based on d-dimer testing, lower-limb venous ultrasonography and multidetector helical computed tomography scan. RESULTS: Pulmonary embolism was ruled out by a d-dimer value <500 microg/l in 28 (23%) patients and a by negative chest computed tomography scan in 91 (74%). Computed tomography scan showed pulmonary embolism in four patients (3.3%, 95% confidence interval (CI), 1.2% to 8%), including three lobar and one sub-segmental embolisms. The prevalence of pulmonary embolism was 6.2% (n = 3; 95% CI, 2.3% to 16.9%) in the 48 patients who had a clinical suspicion of pulmonary embolism and 1.3% (n = 1; 95% CI, 0.3% to 7.1%) in those not suspected. In two cases with positive computed tomography scan, the venous ultrasonography also showed a proximal deep-vein thrombosis. No other patient was diagnosed with venous thrombosis. CONCLUSIONS: The prevalence of unsuspected pulmonary embolism is very low in patients admitted in the emergency department for an acute exacerbation of their COPD. These results argue against a systematic examination for pulmonary embolism in this population.
Keywords
Aged, Cross-Sectional Studies, Female, Fibrin Fibrinogen Degradation Products, Humans, Male, Prevalence, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Pulmonary Embolism, Risk Factors, Tomography, X-Ray Computed
Pubmed
Web of science
Open Access
Yes
Create date
29/01/2008 8:41
Last modification date
20/08/2019 16:08
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