Retrospective evaluation of patients referred to the emergency department with suspected pulmonary embolism for computed tomography angiography

Introduction and Aim: Pulmonary thromboembolism (PTE) is the third most common cause of cardiovascular deaths worldwide, following myocardial infarction and stroke. In patients presenting to the emergency department with symptoms such as dyspnea, chest pain, tachypnea, and syncope, pulmonary embolism is a life-threatening condition that, if left undiagnosed, can increase mortality rates. In our study, in order to standardize the PTE diagnosis processes and to increase the awareness of appropriate test ordering, a form was prepared to be filled before the procedure in patients who applied to the Akdeniz University Hospital Emergency Department between June 2020 and April 2021 and were requested to have a computed tomography examination with a preliminary diagnosis of PTE. In this study, the data collected in these forms were evaluated retrospectively. Material and Methods: Patients who presented to the Akdeniz University Hospital Emergency Department between June 2020 and April 2021, with a preliminary diagnosis of PTE related to their symptoms, and consequently underwent computed angiography, were included in the study. The forms to be completed prior to the computed tomography examination were retrospectively evaluated. Results: The study included 352 patients with a mean age of 55±17 years, of whom 189 (53.7%) were female and 163 (46.3%) were male. Computed pulmonary angiography was performed on all 352 patients, and the prevalence of pulmonary thromboembolism in our study was found to be 11.4% (40 patients). When evaluated using the PERC rule, 327 (92.9%) patients were identified as PERC positive, while 25 (7.1%) patients were PERC negative. No PTE was detected in patients with a negative PERC. According to the Wells algorithm, 149 (42.3%) patients were classified as low risk, 180 (51.1%) as moderate risk, and 23 (6.5%) as high risk. Based on the risk scoring, the prevalence of PTE was 4% in the low-risk group, 15% in the moderate-risk group, and 30.4% in the high-risk group. When evaluated using the YEARS algorithm, 224 (74.7%) patients were deemed unable to exclude PTE, while 76 (25.3%) were deemed able to exclude it In the evaluation of the patients in terms of the YEARS Algorithm, it was evaluated that while PTE could not be excluded in 224 (74.7%) patients, it could be excluded in 76 (25.3%) patients. According to the YEARS algorithm, PTE was detected in 2 of 76 patients excluded, PTE was detected in 31 of 224 patients whose PTE could not be excluded. Conclusion: There is no specific test for diagnosing pulmonary thromboembolism. Studies have shown that the use of PERC, Wells score, D-dimer, and YEARS scores can assist in the diagnosis of pulmonary thromboembolism. The use of computed tomography pulmonary angiography aids in confirming the diagnosis. Based on the studies in the literature and the results of our study, it has been shown that patients with negative PERC can safely exclude PTE. Scoring systems such as Wells and YEARS can be used to classify the risk of PTE and assist in the diagnostic process. Keywords: Pulmonary thromboembolism, d-dimer, PERC, Wells score, YEARS score, Computed Tomography Angiography