Skip to content

What are the clinical predictors of PE?

There are lots in the literature:

SR and Meta-analysis 1966 to 2007 1

Method:

  • n=18 studies with 5997 patients.
  • mean 38% positive scans.
  • lots of heterogeneity so difficult to summarise.

Findings:

Feature Feature Present Feature Absent
LR 95% CI p heterogeneity LR 95% CI p heterogeneity
Chest pain 1.07 0.855–1.33 <0.001 1.00 0.838–1.19 <0.001
Dyspnoea 1.42 1.14–1.78 <0.001 0.521 0.372–0.729 <0.001
Surgery 1.63 1.23–2.12 <0.001 0.897 0.846–0.950 0.019
Active cancer 1.74 1.17–2.59 <0.001 0.925 0.871–0.983 <0.001
Haemoptysis 1.62 1.23–2.15 0.279 0.983 0.948–1.02 0.016
PH VTE 1.47 1.11–1.96 <0.001 0.940 0.895–0.986 0.650

What about LR of the test itself.

NPV of CTPA. Meta-Analysis. 2

n= 6148 in 4 prospective studies. PE prevalence of 24%.

Type 3 month VTE 3 month Fatal PE
All 1.2% 0.1%
Wells >4 2.0% 0.5%
Wells >6 6.3% null

  1. West J, Goodacre S, Sampson F. The value of clinical features in the diagnosis of acute pulmonary embolism: systematic review and meta-analysis. QJM. 2007;100(12):763-769. doi:10.1093/qjmed/hcm113 ↩

  2. Van der Hulle T, van Es N, den Exter P et al. Is normal CTPA safer to rule out acute PE in patients with a likely clinical probability. Thromb Haemost 2017; 117(08):1622-1629. DOI: 10.1160/TH17-02-0076 ↩