ALTERNATIVE DIAGNOSES OF PULMONARY EMBOLISM IN PRIMARY CARE
Disclosure : The Netherlands Heart Foundation funded the study (NHS-2006B237). GlaxoSmithKline and Inverness Medical co-funded the study with unrestricted research grants. All funding sources had no role in the design, conduct, analyses or reporting of the study or in the decision to submit the manuscript for publication.
9 slide(s) – English – 2012-06-29
Introduction: Pulmonary Embolism (PE) often presents with non-specific mild symptoms. A list of alternative diagnoses of PE as seen in primary care might help the primary care physician (PCP) in judging the probability of PE. This study investigated alternative diagnoses in primary care after excluding PE.
Methods: This study is a secondary analysis of the Amsterdam Maastricht Utrecht Study on thromoEmbolism that validated the use of the Wells clinical decision rule for PE combined with point-of-care D-Dimer testing in 598 consecutive adult patients suspected of PE in primary care in the Netherlands. After medical history and physical examination, all patients were referred to secondary care and diagnosed according to local hospital protocols. Medical information about the investigations done to establish a diagnosis, including hospital discharge letters, was retrieved from the PCP. Patients were followed-up for 3 months.
Results: The most frequent alternative diagnoses after excluding PE (n=516) were: thoracic pain/dyspnoea e.c.i. (42.6%), pneumonia (13.0%), myalgia (11.8%), asthma/COPD (4.8%), panic disorder/hyperventilation (4.1%) and respiratory tract infection (2.3%). High risk patients with a Wells score of > 4 or a positive D-Dimer test were significantly more often diagnosed with a clinical severe disease such as pneumonia (OR 1.9; 95%CI 1.3-2.9; p=0.001), while low risk patients with a Wells score of ≤ 4 and a negative D-Dimer test were significantly more often diagnosed with a clinical less severe disease such as thoracic pain/dyspnoea e.ci., myalgia and panic disorder/hyperventilation (OR 0.3; 95%CI 0.2-0.5; p=0.001).
Conclusion: The most common alternative diagnoses of PE in primary care were thoracic pain/dyspnoea e.ci.i, pneumonia and myalgia. High risk patients were more often diagnosed with clinically severe diseases than low risk patients.