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Effect of the PulmonaryEmbolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. The safety of the pulmonaryembolism rule-out criteria (PERC), an 8-item block of clinical criteria aimed at ruling out pulmonaryembolism (PE), has not been assessed in a randomized clinical trial.To prospectively validate the safety of a PERC-based strategy to rule out PE.A crossover cluster-randomized clinical (...) that was not initially diagnosed. The noninferiority margin was set at 1.5%. Secondary end points included the rate of computed tomographic pulmonary angiography (CTPA), median length of stay in the emergency department, and rate of hospital admission.Among 1916 patients who were cluster-randomized (mean age 44 years, 980 [51%] women), 962 were assigned to the PERC group and 954 were assigned to the control group. A total of 1749 patients completed the trial. A PE was diagnosed at initial presentation in 26 patients
, SPECT/CT, Single-Photon, Tomography Scanners, V/Q scan, Wells, X-Ray Computed, cardiac echo, d-dimer, lung embolism, pulmonaryembolism rule out criteria, thoracic ultrasound, ventilation-perfusion scan, ventilation/perfusion scan Optimal Use Report In Brief PUBLISHED : March 2018 Optimal Use Report Recommendations PUBLISHED : March 2018 Optimal Use Report Infographic PUBLISHED : August 2018 Optimal Use Report Science Report PUBLISHED : January 2018 Optimal Strategies for the Diagnosis of Acute (...) Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism | CADTH.ca Find the information you need Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism Published on: March 1, 2018 Project Number: OP0528-000 Product Line: Research Type: Other Diagnostics Result type: Report Pulmonaryembolism (PE) is a blockage of one of the arteries in the lung
PulmonaryembolismPulmonaryembolism - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Pulmonaryembolism Last reviewed: February 2019 Last updated: July 2018 Summary Pulmonaryembolism (PE) is a life-threatening condition resulting from dislodged thrombi occluding the pulmonary vasculature; right heart failure and cardiac arrest may ensue if not aggressively treated. Symptoms include chest pain, dyspnoea, and a sense (...) , and hypercoagulability. These factors are collectively known as Virchow's triad. Cervantes J, Rojas G. Virchow's legacy: deep vein thrombosis and pulmonaryembolism. World J Surg. 2005;29 Suppl 1:S30-4. http://www.ncbi.nlm.nih.gov/pubmed/15818472?tool=bestpractice.com Approximately 51% of deep venous thrombi will embolise to the pulmonary vasculature, resulting in a PE. Huisman MV, Büller HR, ten Cate JW, et al. Unexpected high prevalence of silent pulmonaryembolism in patients with deep venous thrombosis. Chest
Clinical Value of Ultrasonography in Diagnosis of PulmonaryEmbolism in Critically Ill Patients Pulmonaryembolism (PE) is a clinical emergency that will increase the mortality if complicated with unstable hemodynamics. Because of its nonspecific clinical symptoms, it's a great challenge to make a PE diagnosis. The golden standard to diagnose PE is computed tomography of pulmonary artery (CTPA), but a diagnosis of PE also composed of evaluation of PE risk factors, possibilities, and risk (...) stratification. Ultrasonography may detect right ventricle strain related to hemodynamic change, intravascular thrombosis, thrombosis in right heart or pulmonary arteries, pulmonary infarction, and local pleural effusion. Combination of ultrasound and traditional PE possibility evaluation score may further improve the pretest probability of CTPA. A comprehensive ultrasonography may sometimes rule out PE and may disclose other causes for the clinical situations. A heart-lung-vessel-integrated multiorgan
No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonaryembolism Essentials Imaging is warranted in the majority of patients to confirm or rule out pulmonaryembolism (PE). The age-adjusted D-dimer (ADJUST) reduced the number of required imaging tests in patients ≥ 50 years. The YEARS algorithm was designed to improve the efficiency in patients with suspected PE. There was no added value of implementing ADJUST in the YEARS algorithm in our (...) cohort.Background The YEARS algorithm was designed to simplify the diagnostic work-up of pulmonaryembolism (PE) and to reduce the number of necessary computed tomography pulmonary angiography (CTPA) scans. An alternative strategy to reduce the number of CTPAs is the age-adjusted D-dimer cut-off (ADJUST) in patients aged 50 years or older. We aimed to investigate whether a combination of both diagnostic strategies might save additional CTPAs. Methods The YEARS algorithm consists of three items (clinical signs
Blood and Clots Quizlet 1: Oral Contraceptives and PulmonaryEmbolism Blood and Clots Quizlet 1: Oral Contraceptives and PulmonaryEmbolism - CanadiEM Blood and Clots Quizlet 1: Oral Contraceptives and PulmonaryEmbolism In , by Eric Tseng October 27, 2017 Hello Blood & Clots/CanadiEM community! Before we post our blog series on thrombosis and bleeding, we encourage you to test your initial knowledge by going through a few brief case scenarios. These cases were originally posted as part of our (...) ”. On examination, Maria is a well-appearing, average sized young woman. Her vitals reveal T=37C, HR 85, BP 110/90, RR 15, SpO2 99% RA. Head and neck exam is normal. Cardiorespiratory examination is normal and there is no jugular venous distension. The chest pain is not reproducible with palpation or movement. She does endorse mild bilateral calf pain that she attributes to running. ECG performed at triage shows NSR and no signs of S1Q3T3 or RBBB. Question 1: What is the pre-test probability for pulmonary
Approaches to Diagnosing Acute PulmonaryEmbolism in Canada: current practice, challenges, and availability of testing Approaches to Diagnosing Acute PulmonaryEmbolism in Canada: current practice, challenges, and availability of testing | CADTH.ca Find the information you need Approaches to Diagnosing Acute PulmonaryEmbolism in Canada: current practice, challenges, and availability of testing Approaches to Diagnosing Acute PulmonaryEmbolism in Canada: current practice, challenges (...) , and availability of testing Published on: September 8, 2017 Project Number: ES0307-000 Product Line: Result type: Report CADTH undertook an environmental scan to identify and summarize information regarding pulmonaryembolism (PE) imaging in Canada. The scan described current practice, challenges, and enablers in diagnosing PE, and the availability of tests, scans, and tools for diagnosing PE. The key objectives of this environmental scan were as follows: Identify current practice related to diagnostic
Assessing clinical probability of pulmonaryembolism: prospective validation of the simplified Geneva score Essentials The simplified Geneva score allows easier pretest probability assessment of pulmonaryembolism (PE). We prospectively validated this score in the ADJUST-PE management outcome study. The study shows that it is safe to manage patients with suspected PE according to this score. The simplified Geneva score is now ready for use in routine clinical practice.Background Pretest (...) probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonaryembolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva score (SGS) and comparison
Lixiana (edoxaban) - for the prevention of embolism in patients with nonvalvular atrial fibrillation OR treatment of deep vein thrombosis (DVT) and pulmonaryembolism (PE) and prevention of recurrent DVT and PE. Lixiana (edoxaban) × Insert searchphrase to search the website Insert searchphrase to search the website > > > Lixiana (edoxaban) Conclusion Lixiana (edoxaban) is the fourth Non-vitamin K Oral Anticoagulant (NOAC) in Denmark after Eliques (apixaban), Xarelto (rivaroxaban) and Pradaxa (...) (dabigatran). Lixiana is indicated for the prevention of embolism in patients with nonvalvular atrial fibrillation (NVAF) with one or more risk factors and treatment of deep vein thrombosis (DVT) and pulmonaryembolism (PE) and prevention of recurrent DVT and PE. For either indication, Lixiana is not inferior to warfarin when it comes to preventing embolism and has a statistically significantly lower occurrence of major bleeding. The lower risk of bleeding is particularly evident in comparisons
Pulmonaryembolism prognostic factors and length of hospital stay: A cohort study Patients with pulmonaryembolism (PE) are commonly admitted to hospital for their initial treatment. We aimed to assess the association of length of hospital stay with commonly available clinical variables and their combinations.A retrospective multicenter cohort study was conducted on consecutive PE patients admitted to eight Italian centers. Logistic regression analysis was performed to evaluate the association (...) between the length of hospital stay and the PulmonaryEmbolism Severity Index (PESI) parameters, National Early Warning Score (NEWS) and other possible determinants.We enrolled 391 patients, with a median hospital stay of 10days (IQR 7-14). Among PESI parameters, only oxygen saturation <90% was significantly associated with length of hospital stay at univariable analysis (OR 1.99; 95% CI 1.3-3.2). At multivariable analysis, NEWS ≥5 was associated with prolonged hospitalization (OR 3.14; 95% CI 1.2-8.3
Derivation and Validation of a Novel Prediction Model to Identify Low-Risk Patients With Acute PulmonaryEmbolism Accurate identification of low-risk patients with acute pulmonaryembolism (PE) who may be eligible for outpatient treatment or early discharge can have substantial cost-saving benefit. The purpose of this study was to derive and validate a prediction model to effectively identify patients with PE at low risk of short-term mortality, right ventricular dysfunction, and other nonfatal
D-dimer Interval Likelihood Ratios for PulmonaryEmbolism The objective was to estimate D-dimer interval likelihood ratios (iLRs) for diagnosing pulmonaryembolism (PE).The authors used pooled patient-level data from five PE diagnostic management studies to estimate iLRs for the eight D-dimer intervals with boundaries 250, 500, 750, 1,000, 1,500, 2,500, and 5,000 ng/mL. Logistic regression was used to fit the data so that an interval increase corresponds to increasing the likelihood ratio
CRACKCast E088 – PulmonaryEmbolism & Deep Venous Thrombosis CRACKCast E088 - PulmonaryEmbolism & Deep Venous Thrombosis - CanadiEM CRACKCast E088 – PulmonaryEmbolism & Deep Venous Thrombosis In , by Adam Thomas June 29, 2017 This episode of CRACKCast covers Rosen’s Chapter 88, DVT and PE. This episode covers the risk factors, diagnostic approach, treatment and management of PEs and DVTs. Shownotes – Rosen’s in Perspective This chapter is all about VTE – venous thromboembolism (...) therapy (eg, recent surgery, hemorrhagic stroke, active bleeding) Also often considered in patients with recurrent embolism despite adequate anticoagulation 3) What about PE/DVT in pregnancy? DVT / PE Managed with adjusted doses of LMWH for at least 3-6 months (at least 4-6 weeks post-partum) Not recommended: Heparin or Warfarin Do NOT use: Fondaparinux DOAC’s 4) What is the cause of hypoxia in patients with PE? What causes chest pain? What causes hypotension? Hypoxia: due to V/Q mismatch. Areas
The Risk of Deep Venous Thrombosis and PulmonaryEmbolism in Primary Sjogren Syndrome: A General Population-based Study To estimate the future risk and time trends of venous thromboembolism (VTE) in individuals with newly diagnosed primary Sjögren syndrome (pSS) in the general population.Using a population database that includes all residents of British Columbia, Canada, we created a study cohort of all patients with incident SS and up to 10 controls from the general population matched for age (...) , sex, and entry time. We compared incidence rates (IR) of pulmonaryembolism (PE), deep vein thrombosis (DVT), and VTE between the 2 groups according to SS disease duration. We calculated HR, adjusting for confounders.Among 1175 incident pSS cases (mean age 56.7 yrs, 87.6% women), the IR of PE, DVT, and VTE were 3.9, 2.8, and 5.2 per 1000 person-years (PY), respectively; the corresponding rates in the comparison cohort were 0.9, 0.8, and 1.4 per 1000 PY. Compared with non-SS individuals
Simplified diagnostic management of suspected pulmonaryembolism (the YEARS study): a prospective, multicentre, cohort study. Validated diagnostic algorithms in patients with suspected pulmonaryembolism are often not used correctly or only benefit subgroups of patients, leading to overuse of computed tomography pulmonary angiography (CTPA). The YEARS clinical decision rule that incorporates differential D-dimer cutoff values at presentation, has been developed to be fast, to be compatible (...) with clinical practice, and to reduce the number of CTPA investigations in all age groups. We aimed to prospectively evaluate this novel and simplified diagnostic algorithm for suspected acute pulmonary embolism.We did a prospective, multicentre, cohort study in 12 hospitals in the Netherlands, including consecutive patients with suspected pulmonaryembolism between Oct 5, 2013, to July 9, 2015. Patients were managed by simultaneous assessment of the YEARS clinical decision rule, consisting of three items
Update: D-dimer Test for Excluding the Diagnosis of PulmonaryEmbolism TAKE-HOME MESSAGE Patients with a low pretest probability for pulmonaryembolism according to a structured clinical prediction rule and a negative D-dimer result are unlikely to have pulmonaryembolism, particularly among those younger than 65 years. Update: D-dimer Test for Excluding the Diagnosis of PulmonaryEmbolism EBEM Commentators Daniel Kwon, BS Lake Erie College of Osteopathic Medicine Erie, PA Melody Milliron, DO (...) -dimer test. Finally, the review is not able to answer questions about the ability of D-dimer to assess for pulmonaryembolism in pregnant patients. Appropriate use of advanced radiographic imaging has been highlighted through national effortssuchastheChoosingWisely campaign, which aims to improve patient care by avoiding wasteful or unnecessary medical tests, treatments,andprocedures. 3 Using a negative D-dimer test result for patients with low pretest probability based on a clinical decision rule
The use of veno-venous extracorporeal membrane oxygenation following thrombolysis for massive pulmonaryembolism A 59-year-old man was diagnosed with a massive pulmonaryembolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer (...) to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonaryembolism following thrombolysis.
Age-adjusted D-Dimer to Exclude PulmonaryEmbolism Emergency Medicine > Journal Club > Archive > February 2016 Toggle navigation February 2016 Age-adjusted D-Dimer to Exclude PulmonaryEmbolism Vignette You are working in a community ED one afternoon when you encounter Mrs. X, a pleasant 65-year old woman with a history of hypertension and osteoporosis, who is in town visiting her grandchildren from California. She flew in 2 days earlier, and for the last 12 hours has noted some right-sided (...) in additional confirmatory testing (CT, VQ scan). Search Strategy PubMed was searched using the terms "age adjusted d-dimer" ( ). This resulted in 148 articles, from which the following 4 were selected. Article 1: Article 2: Article 3: Article 4: Bottom Line In patients who are not high-risk for pulmonaryembolism, D-dimer has been shown to be effective at ruling out disease. Unfortunately, this test also has a low specificity and a high false-positive risk. This risk increases (and specificity decreases