Ok, its here – the second part of the PE podcast. This is where all the new concepts are squirrelled away. We know that our current approach to PE is imperfect and likely does harm to a good number of patients – so can we do better?
Dr Anand Senthi is back to run us through a few new concepts – the test threshold, the mortality threshold and the role of the simplified PESI score in the prognostication process.
As usual there is a lot of evidence, key papers and scoring systems mentioned – so the links to these are below.
Enjoy, it is 33 minutes and I think might need a second listen if you are new to these ideas…
There was quite twitter debate a few weeks back when we started tweeting about some of these concepts – and it was hard to explain in 140 characters, so hopefully this podcast does the concepts more justice. Would be keen to hear your opinions on the comments or Tweet me and @DrSenthi .
Here is a rough visual roadmap through Anand’s PE work up algorithm. Looks complex, but it is really simple to do – faster than getting consent for a CTPA I reckon. All the data you need is in your initial clinical assessment – just plug it into MDCalc and Bob’s your uncle!
Pines and Lessler (Acad Emerg Med, 2012) performed the “mortality benefit threshold” calculations – i.e. how much benefit would treatment have to achieve in order to make a work-up worthwhile in a given pretest risk cohort? In the low risk group it works out at about 20%…. so you would need to have an intervention that dropped mortality by 20%…. this is not proven or even likely with current anticoagulation drugs!
The Simplified PESI (PE severity index) score on MDCalc – a tool to predict will do well after the diagnosis of PE. If your sPESI is = 0, you are really very unlikely to die from a PE. Jimenez et al showed the mortality risk was 1%, then subsequent prospective studies have shown even lower “treated mortality” rates
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact