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Is the perfusion lung-scan still useful for the diagnosis approach towards lung embolism suspicion in the emergency department?

par Tondeur, Marianne ;Mols, Pierre ;Ham, Hamphrey
Référence Journal européen des urgences, 20, 4, page (153-157)
Publication Publié, 2007-12

Article révisé par les pairs

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Résumé :

Objectives: Pulmonary embolism is a potentially fatal condition whose diagnosis requires helical CT scan or perfusion/ventilation scan. In emergency situations these techniques may be unavailable. The question was whether lung-perfusion scan alone could still be used as triage in an emergency department? Methods: This prospective study was performed when both helical CT scan and ventilation/perfusion scan were unavailable. During one year, 53 patients admitted to the emergency department and possibly suffering from pulmonary embolism had perfusion scan as first procedure. The referring emergency physician was thereafter asked whether the perfusion scan had an impact on patient's management and decision-making. The results of this examination were also compared to the final diagnosis at hospital's discharge. Results: Perfusion scan had an important impact in 39 patients (74%). Nine out of the 16 patients whose perfusion scan was interpreted as high probability for pulmonary embolism had pulmonary embolism as final diagnosis. None of the 14 patients with normal perfusion scan and none of the 23 patients with abnormal and equivocal perfusion scan had pulmonary embolism as final diagnosis. Conclusion: This study demonstrates that perfusion scintigraphiy used alone remains useful as it will allow the possibility to exclude embolism in more than 20% of the cases and as it will justify the initiation of appropriate treatment in about 30% of the cases. It also shows that perfusion scan has an important impact on patient's management in more than 70% of the cases. © 2007 Elsevier Masson SAS. All rights reserved.