Chest

Chest

Volume 95, Issue 2, February 1989, Pages 332-337
Journal home page for Chest

Prospective Study of a Standardized Questionnaire to Improve Clinical Estimate of Pulmonary Embolism†

https://doi.org/10.1378/chest.95.2.332Get rights and content

A standardized questionnaire was administered to 100 patients suspected of having pulmonary embolism to investigate whether clinical data may be reliably used in the decision-making process of such patients. Questionnaire data were compared with lung scintigraphy outcome and 16 variables were selected as significantly associated with the scintigraphic diagnosis. Based on these variables, patients with abnormal scintigraphy compatible with pulmonary embolism and patients with scintigraphy not compatible with embolism were classified in accordance with the scintigraphic diagnosis. When these 16 variables were tested in an additional validation group, clinical and scintigraphic diagnosis matched in most cases. These results show that clinical data can be used to predict the outcome of lung perfusion scintigraphy in patients suspected of pulmonary embolism. Use of a standardized questionnaire can improve the accuracy of pretest assessment of such patients and positively influence the decisions to start heparin coverage or obtain pulmonary angiography.

(Chest 1989; 95:332-37)

Section snippets

Study Population

Two-hundred thirty-two consecutive patients referred during one year because of clinical suspicion of recent onset pulmonary embolism (symptoms within 14 days of evaluation) were studied. Patients were referred from both medical (57 percent) and surgical (28 percent) departments of the University Hospital and from the emergency room (15 percent). Once referred, patients were not further selected. To collect data related to history and physical examination, a standardized questionnaire was

RESULTS

According to the described criteria, 97 patients (46 males) were classified as having pulmonary embolism and 80 (34 males) as normal or affected by diseases different from embolism. In particular, the embolic group was defined as follows: 77 patients showed a substantial improvement of pulmonary perfusion at the follow-up scan while eight patients having negligible or missing improvement had evidence of over 50 percent perfusion impairment either in the presence of clinical findings strongly

DISCUSSION

Detailed clinical assessment of patients suspected of pulmonary embolism, although not diagnostic, may help clinicians in many different steps of the diagnostic process for pulmonary embolism, such as raising the suspicion,9,17,18 instituting heparin coverage when diagnostic procedures are not promptly available19, 20 or deciding to perform pulmonary arteriography.19 Many papers suggest the need for a greater input to clinicians to guide the referral for pulmonary arteriography.3,19-21 The

ACKNOWLEDGMENTS

We thank G. Rossi, Bs.D., for assistance in arranging the questionnaire and Mrs. Emanuela Campani for typing the manuscript.

REFERENCES (24)

  • PallaA et al.

    When pulmonary embolism should be suspected on clinical grounds.

    Am Rev Respir Dis

    (1984)
  • MariniC et al.

    Perfusion scintigraphy versus pulmonary arteriography in the diagnosis of pulmonary embolism.

    J Nucl Med Allied Sci

    (1978)

    • Cited by (0)

    †

    Research and Medical Services, Brigham and Women's Hospital, Brockton-West Roxbury Veterans Administration Medical Center; and Harvard Medical School, Boston.

    This work was supported in part by C.N.R. National Cardiorespiratory Group grant CT 86.00444.04.

    Manuscript received June 8, 1987; revision accepted June 9, 1988.

    View full text
    Copyright © 1989 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.