Article - Limited access to UNIGE
Other version: http://onlinelibrary.wiley.com/store/10.1111/j.1538-7836.2009.03667.x/asset/j.1538-7836.2009.03667.x.pdf?v=1&t=h1qigk...
Volumetric or time-based capnography for excluding pulmonary embolism in outpatients?
|Published in||Journal of Thrombosis and Haemostasis. 2010, vol. 8, no. 1, p. 60-67|
|Abstract||BACKGROUND: Volumetric capnography is technically more demanding but theoretically better than the time-based alveolar deadspace fraction (P(a)CO(2) - EtCO(2))/P(a)CO(2) as a bedside diagnostic tool for excluding pulmonary embolism (PE) in outpatients. OBJECTIVE: We compared both diagnostic accuracy in patients with a suspected PE and positive D-dimer enzyme-linked immunosorbent assay results. PATIENTS AND METHODS: In this clinical multicenter trial with prospective inclusion and 3-month follow-up, alveolar deadspace fraction was compared by receiver operating characteristic (ROC) analysis with other parameters derived from volumetric capnography. RESULTS: Capnography was performed in 239 patients, and 205 tests (86%) were conclusive. The incidence of PE was 33%. The alveolar deadspace fraction accuracy expressed with ROC curve analysis was 0.73 +/- 0.04. The diagnostic performances of parameters from volumetric capnography were not significantly better. Sixteen per cent [95% confidence interval (CI) 12-21%] of patients presented a (P(a)CO(2) - EtCO(2))/P(a)CO(2) ratio under the cut-off value of 0.15, with a low clinical probability. This combination excluded PE, with a sensitivity of 96% (95% CI 89-99%) and a negative likelihood ratio of 0.17 (95% CI 0.09-0.33%). CONCLUSION: Volumetric capnography failed to show superiority to alveolar deadspace fraction measurements [(P(a)CO(2) - EtCO(2))/P(a)CO(2)] for exclusion of PE in outpatients with positive D-dimer test results. Future studies should clarify the safety of excluding PE in patients combining low clinical probability with positive D-dimer results and (P(a)CO(2) - EtCO(2))/P(a)CO(2) ratios below the cut-off value of 0.15.|
|Keywords||Aged — Aged, 80 and over — *Capnography — Carbon Dioxide/*metabolism — Enzyme-Linked Immunosorbent Assay — Europe — Fibrin Fibrinogen Degradation Products/metabolism — Humans — Likelihood Functions — Middle Aged — *Outpatients — *Point-of-Care Systems — Predictive Value of Tests — Prospective Studies — Pulmonary Embolism/blood/*diagnosis/metabolism — ROC Curve — *Respiratory Dead Space — Sensitivity and Specificity — Time Factors|
Faculté de médecine / Section de médecine clinique / Département de médecine interne des spécialités
|Research groups||Groupe Perrier Arnaud (Médecine interne générale, de réhabilitation et de gériatrie) (585)|
La maladie thromboembolique veineuse (808)
|VERSCHUREN, F. et al. Volumetric or time-based capnography for excluding pulmonary embolism in outpatients?. In: Journal of Thrombosis and Haemostasis, 2010, vol. 8, n° 1, p. 60-67. https://archive-ouverte.unige.ch/unige:21372|