PE Prognostication with Dr Anand Senthi

This is the first of a 2-part podcast, and it is long!

This podcast was inspired by Dr Anand Senthi –  a Snr Registrar in Emergency Medicine in Perth, W. Australia.

Anand gave an awesome and entertaining talk at the ACEM Winter Symposium in Broome back in June – and I have been wanting to get him onto the podcast ever since.

This is all about the diagnostic and prognostic approach to the low-risk ?PE patients in the Emergency department.  To be clear – we are discussing patients who have low-risk based on Clinical Gestalt, Well’s score or PERC negative.   These are the patients at the ground level of the “PE Pyramid”.

We are talking about the folks at the bottom of this diagram...

We do discuss a heap of evidence and scoring systems in this podcast.  So I have put a list of links to the original articles and online Clinical Decision Rules below.

MDCalc (by Dr Graham Walker) has a great set of free online tools for common clinical decisions:

Well’s score

PERC score

Original, Revised and Simplified Geneva scores

Articles to ponder:

The Barritt_& Jordan 1960 trial was published in the Lancet. 1960 Jun 18;1(7138):1309-12.  Big thanks to Dr Andy Neil of Emergency Medicine Ireland for sending this copy – love the FOAM!

The Nielsen paper from Journ. Internal Med in 1994 which compared patients with DVT treated with anticoagulation vs. an NSAID.

The Shulman trial from NEJM in 1995 looked at short vs. longer term anticoagulation for VTE recurrence rates.

PIOPED II study that was the original prospective evaluation of CTPA against a “gold standard”

Here are a few trials that looked at age-adjusted D-dimer values (Ed:  my error it was not Kline who did this validation trial.  He did do a lot of others though in my defence!]

This Dutch derivation of the  age x 10 microgram formula was useful – especially in the > 70 yos

This German validation used the formula age × 0.016 mg/l for a more useful “cut-off” D dimer in older people.

Rob Orman’s podcast with Jeff Kline on PE in Pregnancy is gold – check it out!

Now I know – for many of you there is not too much new in this podcast – but just wait!  IN the next instalment Anand delivers his take on the other side of the coin – the prognostication and risk side of the investigation and treatment of PE.  Stay tuned – it is a bit new and might change the way you do business in your ED. Will release it later this week after you have digested part 1!




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