Abstract：
Despite diagnostic algorithms, identification of venous thromboembolism (VTE) in emergency departments (ED) remains a challenge. We evaluated symptoms, background, and laboratory data in 27,647 ED patients presenting with pain, swelling, or other symptoms from the extremities, and identified predictors of VTE diagnosis within one year. Predictors of a clinical decision to perform phlebography, ultrasound, or computer tomography (CT) angiography of pelvic, lower, or upper extremity veins, CT of pulmonary arteries, or pulmonary scintigraphy at the ED or within 30 days, and the results of such investigations were also evaluated. A total of 3195 patients (11.6%) were diagnosed with VTE within one year. In adjusted analysis of patients in whom all laboratory data were available, a d-dimer value ≥ 0.5 mg/l (odds ratio [OR]: 2.602; 95% confidence interval [CI] 1.894-3.575; p < 0.001) at the ED and a previous diagnosis of VTE (OR: 6.037; CI 4.465-8.162; p < 0.001) independently predicted VTE within one year. Of diagnosed patients, 2355 (73.7%) had undergone imaging within 30 days after the ED visit and 1730 (54.1%) were diagnosed at this examination. Lower age (OR: 0.984; CI 0.972-0.997; p = 0.014), higher blood hemoglobin (OR: 1.023; CI 1.010-1.037; p < 0.001), C-reactive protein (OR: 2.229; CI 1.433-3.468; p < 0.001), d-dimer (OR: 8.729; CI 5.614-13.574; p < 0.001), and previous VTE (OR: 7.796; CI 5.193-11.705; p < 0.001) predicted VTE on imaging within 30 days, whereas female sex (OR 0.602 [95% CI 0.392-0.924]; p = 0.020) and a previous diagnosis of ischemic heart disease (OR 0.254 [95% CI 0.113-0.571]; p = 0.001) were negative predictors of VTE. In conclusion, analysis of 27,647 ED patients with extremity symptoms confirmed the importance of well-established risk factors for VTE. Many patients developing VTE within one year had initial negative imaging, highlighting the importance of continued symptom vigilance.
摘要：
尽管有诊断算法，在急诊科(ED)中识别静脉血栓栓塞症(VTE)仍然是一个挑战.我们评估了症状，背景,以及27,647名出现疼痛的ED患者的实验室数据，肿胀,或其他四肢症状，并确定了一年内VTE诊断的预测因子。进行静脉造影的临床决策的预测因子，超声，或骨盆的计算机断层扫描（CT）血管造影，较低,或者上肢静脉,肺动脉CT,或在ED或30天内进行肺部闪烁显像，并对此类调查的结果进行了评估。一年内共3195例（11.6%）确诊为VTE。在对所有实验室数据均可用的患者的调整分析中，在ED和既往诊断为VTE(OR:6.037;CI4.465-8.162;p<0.001)时,d-二聚体值≥0.5mg/l(比值比[OR]:2.602;95%置信区间[CI]1.894-3.575;p<0.001)可独立预测一年内的VTE.在确诊的患者中，2355（73.7％）在ED访问后30天内接受了影像学检查，1730（54.1％）在此检查中被诊断出。年龄较低（OR：0.984；CI0.972-0.997；p=0.014），高血红蛋白（OR：1.023；CI1.010-1.037；p<0.001），C反应蛋白（OR：2.229；CI1.433-3.468；p<0.001），d-二聚体（OR：8.729；CI5.614-13.574；p<0.001），和既往VTE（OR：7.796;CI5.193-11.705;p<0.001）预测30天内成像的VTE，而女性(OR0.602[95%CI0.392-0.924];p=0.020)和既往诊断为缺血性心脏病(OR0.254[95%CI0.113-0.571];p=0.001)是VTE的阴性预测因子。总之,对27,647例有肢体症状的ED患者的分析证实了已确定的VTE危险因素的重要性。许多在一年内发展为VTE的患者最初的影像学检查为阴性。强调持续警惕症状的重要性。
