Date of Award

2019

Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)

Department

Physician Assistant Studies

First Advisor

Eric Barth

Abstract

Background: Pulmonary embolism (PE) is a serious and potentially life-threatening complication of venous thromboembolism and its diagnosis remains a challenge. The current gold standard to confirm diagnosis of PE is multi-row computed tomography pulmonary angiography (CTPA) but has limitations and alternative imaging modalities are being investigated. Point-of-care ultrasound (POCUS) has been applied in the diagnostic process in PE but whether it can safely replace the gold standard is of question.

Methods: A literature review was conducted to evaluate the sensitivity of single versus multiorgan point-of-care ultrasound (POCUS) compared to CTPA in detecting PE in adult patients.

Discussion: Several prospective observational studies exist investigating the use of single and multiorgan POCUS but are inconsistent in the selection of subjects, diagnostic reference tests used for comparison, criteria for PE diagnosis on POCUS and combinations of multiorgan POCUS used. A limited number of studies exist for each of the combinations of multiorgan POCUS investigated.

Conclusion: Both single organ and multiorgan POCUS have shown inferior sensitivity to CTPA and cannot replace this diagnostic gold standard for PE. Triple multiorgan POCUS (lung, cardiac, and vascular) has shown the most promise thus far (sensitivity of 90%, specificity of 86%) and is recommended for patients that cannot receive CTPA and an adjunct to help provide alternative cardiopulmonary diagnoses, potentially reducing unnecessary radiographic imaging and may help to improve the prediction rules in stratifying risk for patients clinical suspicion of PE. More consistent research is needed to clarify the role and validity of POCUS in PE.

Identifier

SC 11.PAS.2019.Stangene.J

Download

Included in

Pulmonology Commons

Share

COinS