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Reducing exposure to medical radiation in evaluation of suspected pulmonary embolism (PE) in pregnancy
PE presents a particular diagnostic challenge in pregnancy with no validated algorithm and lower utility of d-dimer testing. Furthermore, imaging modalities hold increased risk in terms of radiation exposure for mother and fetus. The YEARS algorithm for risk stratification in PE has been validated in non-pregnant patients and successfully reduces diagnostic imaging. Pol et al (NEJM 2019;380:1139) evaluated whether a pregnancy adapted version of this algorithm was safe and effective. Pregnant woman presenting with symptoms suggestive of PE to units across Europe were included in the study (n=498). Patients were evaluated using d-dimer and three clinical features (clinical signs of deep vein thrombosis (DVT), haemoptysis and clinician assessment that thrombosis was the most likely diagnosis). Those with clinical signs of a DVT went immediately for lower limb ultrasonography. Those without were stratified. If d-dimer was >1000 ng/mL, or if d-dimer was >500 ng/mL and one of the three clinical criteria were met, a CT pulmonary angiogram was performed; otherwise, DVT/PE was considered ruled out. Participants were followed up for 3 months. Using this algorithm, 20 patients (4%, 95% CI 2.6% to 6.1%) were diagnosed with DVT/PE at presentation. Of the patients stratified as low risk, one patient was diagnosed with a DVT during follow-up but none with PE. Use of the …
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