Jurnal Internasional Afrika vol.9 issue .3 2019
African Journal of Emergency Medicine
Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population
Dublin Core
Title
Jurnal Internasional Afrika vol.9 issue .3 2019
African Journal of Emergency Medicine
Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population
African Journal of Emergency Medicine
Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population
Subject
TB.
Pulmonary embolism
HIV
Diagnosis of pulmonary embolism
Pulmonary embolism
HIV
Diagnosis of pulmonary embolism
Description
Introduction: The diagnosis of pulmonary embolism (PE) is challenging to make and is often missed in the
emergency centre. The diagnostic work-up of PE has been improved by the use of clinical decision rules (CDRs)
and CT pulmonary angiography (CTPA) in high-income countries. CDRs have not been validated in the South
African environment where HIV and tuberculosis (TB) are highly prevalent. Both conditions are known to induce
a hyper-coagulable state. The objective of this study was to describe the clinical presentation and diagnostic
workup of suspected PE in our setting and to determine the prevalence of HIV and TB in our sample of patients
with confirmed PE.
Methods: This study was a retrospective chart review of patients with suspected PE who had CTPAs performed
between October 2013 and October 2015 at a district hospital in Cape Town, South Africa. Data were collected
on demographics, presenting signs and symptoms, vitals, bedside investigations, HIV and TB status. A Revised
Geneva score (RGS) was calculated retrospectively and compared to the CTPA result.
Results: The median age of patients with confirmed PE was 45 years and 68% were female. The CTPA yield for
PE in our study population was 32%. The most common presenting complaint was dyspnoea (83%). Deep venous
thrombosis (DVT) was present in 29%. No sign or symptom was observed to be markedly different in patients
with confirmed PE vs no PE. Among patients with confirmed PE, 37% were HIV positive and 52% had current
TB. RGS compared poorly with CTPA results.
Conclusions: PE remains a diagnostic challenge. In our study, the retrospectively calculated CDR was not pre-
dictive of PE in a population with a high prevalence of HIV and TB. Emergency physicians should be cautious
when making a clinical probability assessment of PE in this setting. However, further studies are needed to
develop a predictive CDR for the local environment.
emergency centre. The diagnostic work-up of PE has been improved by the use of clinical decision rules (CDRs)
and CT pulmonary angiography (CTPA) in high-income countries. CDRs have not been validated in the South
African environment where HIV and tuberculosis (TB) are highly prevalent. Both conditions are known to induce
a hyper-coagulable state. The objective of this study was to describe the clinical presentation and diagnostic
workup of suspected PE in our setting and to determine the prevalence of HIV and TB in our sample of patients
with confirmed PE.
Methods: This study was a retrospective chart review of patients with suspected PE who had CTPAs performed
between October 2013 and October 2015 at a district hospital in Cape Town, South Africa. Data were collected
on demographics, presenting signs and symptoms, vitals, bedside investigations, HIV and TB status. A Revised
Geneva score (RGS) was calculated retrospectively and compared to the CTPA result.
Results: The median age of patients with confirmed PE was 45 years and 68% were female. The CTPA yield for
PE in our study population was 32%. The most common presenting complaint was dyspnoea (83%). Deep venous
thrombosis (DVT) was present in 29%. No sign or symptom was observed to be markedly different in patients
with confirmed PE vs no PE. Among patients with confirmed PE, 37% were HIV positive and 52% had current
TB. RGS compared poorly with CTPA results.
Conclusions: PE remains a diagnostic challenge. In our study, the retrospectively calculated CDR was not pre-
dictive of PE in a population with a high prevalence of HIV and TB. Emergency physicians should be cautious
when making a clinical probability assessment of PE in this setting. However, further studies are needed to
develop a predictive CDR for the local environment.
Creator
Bojana Bulajic, Tyson Welzel, Kamil Vallabh
Source
https://doi.org/10.1016/j.afjem.2019.05.003
Date
17 May 2019
Contributor
peri irawan
Format
pdf
Language
ENGLISH
Type
text
Files
Citation
Bojana Bulajic, Tyson Welzel, Kamil Vallabh, “Jurnal Internasional Afrika vol.9 issue .3 2019
African Journal of Emergency Medicine
Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1768.
African Journal of Emergency Medicine
Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1768.