The article for this module’s Journal Club is “Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis” This article is password protected. Please feel free to comment on this article.
Journal Club is scheduled for Wednesday, August 7th and will be presented by Dr. Grock.
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richard.shin
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4 Comments
basile · July 25, 2013 at 10:36 pm
This review included articles that were dissimilar and can lead to bias.
The overall prevalence of PE was 17%, but if you look at the prevalence in the only study that included only ED patients, the prevalence was only 3.3%.
Also, in the ED study, the percentage of patients with malignancy was only 5% as compared to another study (with PE prevalence of 25%) where the percentage of patients with malignancy was 29%.
Nobody would argue that a population with a high percentage of patients with malignancy presenting with sob/chest pain would have a high prevalence of PE. However, this is a different point than saying that patients with COPD have a higher prevalence of PE.
wendyrollerblades · August 1, 2013 at 9:14 pm
thanks for clarifying the prevalence in ED pts
melton · July 30, 2013 at 3:15 pm
Agreed the studies really just bring to light that you should not ignore the differential for acute COPD exacerbation.
Airway viral infection
Bacterial infection (including pneumonia)
Co-infection
Depression and anxiety
Embolism (pulmonary)
Failure (cardiac or lung integrity in a pneumothorax)
General environment
No specific cause identified (I believe our module reading reports this is one third of the time)
And it seems almost a no brainer to consider PE in someone with an intermediate to high pre-test probability for PE. Especially those with a malignancy, history of clot, immobilization ect. And the paper makes a good point that our scoring systems for PE are not validated for someone having a COPD exacerbation. And the D-Dimer is not helpful.
TSmith · August 6, 2013 at 10:23 pm
I agree with you, Joe and Jay. Given the prevalence was 3.3% in the ED patients, I wonder if we would miss these patients or would they get ruled out for PE because of some other very obvious risk factor (like malignancy).