Velmahos et al used a variety of findings to determine the clinical suspicion of pulmonary embolism (PE) in surgical patients. This can help identify patients who require imaging studies for diagnosis. The authors are from USC in Los Angeles.
Parameters:
(1) arterial oxygen saturation
(2) infiltrate on chest radiograph
(3) change in PaO2 to FIO2 ratio
(4) change in systolic blood pressure
(5) pain limiting chest movement
(6) thromboprophylaxis
(7) risk factors for deep vein thrombosis (DVT)
(8) PaCO2
Risk factors for deep vein thrombosis:
(1) age > 55 years
(2) fracture to lower extremity, spine or pelvis
(3) head injury
(4) pelvic operations
(5) history of hypercoagulable condition (not in original list of risk factors)
|
Parameter |
Finding |
Points |
|
arterial oxygen saturation |
acute desaturation <= 94% |
1 |
|
|
oxygen saturation > 94% |
0 |
|
|
chronic desaturation <= 94% |
0 |
|
chest radiograph |
no new infiltrate |
1 |
|
|
new infiltrate present |
0 |
|
PaO2 to FIO2 ratio |
sudden drop to <= 200 in the absence of new sepsis |
1 |
|
|
sudden drop to <= 200 with new sepsis |
0 |
|
|
no sudden drop |
0 |
|
systolic blood pressure |
sudden drop to <= 90 mm Hg in the absence of new sepsis or blood volume loss |
1 |
|
|
sudden drop to <= 90 mm Hg with new sepsis and/or blood volume loss |
0 |
|
|
no sudden drop to <= 90 mm Hg |
0 |
|
pain |
absence of thoracoabdominal pain that limits chest movements |
1 |
|
|
presence of pain |
0 |
|
thromboprophylaxis |
none or inadequate |
1 |
|
|
adequate |
0 |
|
risk factors for DVT |
>= 1 |
1 |
|
|
0 |
0 |
|
PaCO2 |
sudden drop to <= 40 mm Hg in patient with spontaneous breathing |
1 |
|
|
> 40 mm Hg in patient spontaneously breathing |
0 |
|
|
<= 40 mm Hg in patient on ventilator |
0 |
|
|
gradual drop to <= 40 mm Hg in patient spontaneously breathing |
0 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the clinical suspicion for pulmonary embolism.
|
Score |
Suspicion for PE |
|
0 |
very low |
|
1 or 2 |
low |
|
3 or 4 |
intermediate |
|
5 to 8 |
high |
Performance:
• Clinical findings alone may not indicate the presence of a pulmonary embolus in a critically ill surgical patient, so that a high index of suspicion is warranted.
Specialty: Pulmonology
ICD-10: ,
