A Simple Clinical Model Composed of ECG, Shock Index, and Arterial Blood Gas Analysis for Predicting Severe Pulmonary Embolism
- 2 December 2009
- journal article
- research article
- Published by SAGE Publications in Clinical and Applied Thrombosis/hemostasis
- Vol. 17 (2), 188-196
- https://doi.org/10.1177/1076029609351877
Abstract
Background: Objective diagnosis of severe pulmonary embolism (PE) is obligatory because of its considerable mortality. Aim: To assess the abilities of electrocardiography (ECG) score (sECG) and the newly generated scoring system composed of the scores obtained from arterial blood gas (ABG) analysis and shock index (SI) in addition to sECG in predicting severe PE. Material and Methods: The degree of pulmonary vascular obstruction (sPVO) and the right ventricular dysfunction (RVD) were determined with spiral computed tomography (CT) in 53 consequent patients with PE. Twelve-lead ECG taken within a day of PE event and ABG values were evaluated according to ECG scoring system and original Geneva system, respectively. Results: The mean age of patients was 62.6 ± 13.4 years. Right ventricular dysfunction, sPVO ≥ 50%, hypoxemia, and SI were present in 34 (64.2%), 27 (50.9%), 50 (94.3%), and 22 (41.5%) patients, respectively. The mean sECG, 5.9 ± 5.1, was correlated with sPVO, maximum diameter of right ventricle (RV), and right ventricle to left ventricle (RV/LV) ratio (r = .385, r = .415, and r = .329, respectively). The mean newly generated score was 10.9 ± 5.5 and correlated with sPVO, maximum diameter of RV, and RV/LV ratio (r = .394, r = .483, and r = .393, respectively). Receiver operator characteristic (ROC) curve analyses revealed that sECG ≥ 3.5, s (ECG + SI) ≥ 4.5, and s (ECG + SI + ABG) ≥ 9.5 predict the severe PE patients with 70.6%, 61.8%, 58.8% sensitivities and 52.6%, 63.2%, 73.7% specificities, respectively. Conclusion: Adding the scores obtained from SI and ABG to the sECG enhances the specificity of sECG in predicting RVD (+) or severe PE patients, although a lesser degree decreasing in sensitivity may occur.Keywords
This publication has 45 references indexed in Scilit:
- N-Terminal Pro-B-Type Natriuretic Peptide Predicts the Burden of Pulmonary EmbolismThe American Journal of the Medical Sciences, 2009
- Massive Pulmonary Emboli and CT Pulmonary AngiographyRespiration, 2008
- Enlarged Right Ventricle Without Shock in Acute Pulmonary Embolism: PrognosisThe American Journal of Medicine, 2008
- A New Clinical Model in Pulmonary Embolism and Its Correlation With V/P Scan ResultsClinical and Applied Thrombosis/hemostasis, 2006
- Usefulness of Bedside Testing for Brain Natriuretic Peptide to Identify Right Ventricular Dysfunction and Outcome in Normotensive Patients With Acute Pulmonary EmbolismThe American Journal of Cardiology, 2006
- Spiral computed tomography is the first-line chest imaging test for acute pulmonary embolism: yesJournal of Thrombosis and Haemostasis, 2005
- Urokinase-streptokinase embolism trial. Phase 2 results. A cooperative studyJAMA, 1974
- An Angiographic Severity Index for Pulmonary EmbolismCirculation, 1973
- Comparison of Streptokinase and Heparin in Treatment of Isolated Acute Massive Pulmonary EmbolismBMJ, 1971
- Urokinase pulmonary embolism trial. Phase 1 results: a cooperative studyJAMA, 1970