Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT04882579 |
Other study ID # |
PulmonaryEmbolismPoCUSOdense |
Secondary ID |
|
Status |
Completed |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
June 15, 2021 |
Est. completion date |
July 1, 2023 |
Study information
Verified date |
November 2023 |
Source |
Odense University Hospital |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Pulmonary embolism (PE) is a common cardiovascular condition with an estimated incidence of
0.60 to 1.12 per 1000 inhabitants in the United States of America, and the diagnosis is
challenging as patients with PE present with a wide array of symptoms.
Computed tomography pulmonary angriography (CTPA) and lung ventilation-perfusion scintigraphy
(VQ) are considered the gold-standards in PE-diagnostics but may not always be feasible. CTPA
is contraindicated by contrast allergy or renal failure and both modalities require
involvement of multiple staff-members and transport of the patient. Lung scintigraphy cannot
be performed in an emergency situation, with unstable patients and patients unable to comply
to the examination.
Ultrasound represent a possible tool in confirming or dismissing clinical PE suspicion.
Ultrasound is non-invasive and can be performed bedside by the clinician, an approach known
as point-of-care ultrasound (PoCUS), reducing both time, radiation-exposure and costs.
The aim of this study is to investigate whether integrating cardiac, lung and deep venous
ultrasound in the clinical evaluation of suspected PE reduces the need for referral to CTPA
or lung scintigraphy, during emergency department work up, while maintaining safety
standards.
Description:
All ultrasound examinations will be performed by a physician certified in ultrasound by the
Danish Society for Emergency Physicians in accordance with the Danish Health Agency.
Based on ultrasonographic findings, PE suspicion is allocated to one of three categories:
1. Clinical suspicion of PE confirmed if ≥1 of the following ultrasound findings:
1. Visible proximal deep venous thrombus
2. ≥2 hypoechoic subpleural lung consolidations with a diameter of ≥0,5cm
3. Visible right ventricular thrombus
4. McConnell's sign if no known pulmonary hypertension, interstitial lung disease, COPD or
pulmonary valve disease
5. D-sign present in both systole and diastole if no known pulmonary hypertension,
interstitial lung disease, COPD or pulmonary valve disease
If PE is confirmed by ultrasound, the physician will apply the simplified pulmonary embolism
severity index score (sPESI) and estimate risk of mortality within 30 days based on clinical
signs and symptoms, cardiac troponin level and RV dysfunction. Patients with
intermediate-high or high risk, requiring admission to a cardiology department will be
referred for CTPA. Patients with low or intermediate-low risk, not requiring admission, will
be discharged with anticoagulative treatment.
A thorough presentation of the sPESI-score and early mortality risk assessment is available
in the 2019 collaborative guidelines by the ERS and ESC on the diagnosis and management of
PE.
2. Further diagnostic imaging (CTPA or V/Q) required if ≥1 of the following ultrasound
findings:
1. 1 hypoechoic subpleural lung consolidation with a diameter of ≥0,5cm
2. Pleural effusion not explained by other cause
3. Basal RVEDD/LVEDD >1.0 or an RV visibly larger than the LV
4. TAPSE <17 mm
5. No deep venous thrombus, no lung consolidation or effusion, no signs of RV strain or
thrombus but strong clinical suspicion.
6. McConnell's or D-sign in the presence of known pulmonary hypertension, interstitial lung
disease, COPD or pulmonary valve disease
If PE suspicion can be neither dismissed nor confirmed after ultrasound investigation, the
patient will be referred to further investigation as usual with CTPA or lung scintigraphy.
Subsequent plan will be in accordance with department guidelines.
3. Clinical suspicion of PE dismissed if ≥1 of the following ultrasound findings:
1. No deep venous thrombus, no lung consolidation or effusion, no signs of RV strain or
thrombus and a plausible differential diagnosis or low clinical suspicion
2. Obvious differential diagnosis demonstrated on ultrasound (i.e., pneumonia,
pneumothorax, interstitial syndrome, left sided heart failure)
If PE suspicion is dismissed by ultrasound investigation, the patient will be either
discharged or subject to further investigations in accordance with department guidelines if
indicated.