Chest ACCP Member Benefits
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (8)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Iles, S.
Right arrow Articles by Beckert, L. E. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Iles, S.
Right arrow Articles by Beckert, L. E. L.
(Chest. 2004;125:1651-1656.)
© 2004 American College of Chest Physicians

ECG Score Predicts Those With the Greatest Percentage of Perfusion Defects Due to Acute Pulmonary Thromboembolic Disease*

Stephen Iles, MRCP; Campbell J. Le Heron; Gwyn Davies, MRCP; John G. Turner, MD and Lutz E. L. Beckert, MD, FCCP

* From the Canterbury Respiratory Research Group (Dr. Iles and Mr. Le Heron); and Department of Medicine (Drs. Davies, Turner, and Beckert), Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, Otago, New Zealand.

Correspondence to: Stephen Iles, MRCP, Department of Respiratory Medicine, Royal Cornwall Hospital, Treliske, Cornwall TR4 3LJ, United Kingdom; e-mail: steveiles{at}doctors.org.uk

Background: More aggressive management may be warranted for patients with acute pulmonary embolism (PE) and the greatest pulmonary vascular obstruction. We hypothesized that a scoring system based on the ECG might identify such patients.

Methods: Consecutive patients investigated for PE at Christchurch Hospital between 1997 and 2002 with high-probability ventilation/perfusion (/) scan findings were studied. The ECG obtained closest to and within 48 h of the scan was scored by two independent observers, and the mean ECG score was calculated. / scan findings were categorized into those with < 30%, 30 to 50%, and > 50% perfusion defect by two independent observers experienced in / interpretation. A consensus score was taken when disagreement occurred.

Results: Two hundred twenty-nine patients were included in the study. The interobserver agreement for ECG score was 0.96 (Cronbach {alpha}) and / score was 0.55 ({kappa}). The ECG predicted those with the greatest amount of perfusion defects. Mean ECG score was 2.6 (SD 2.8) in patients with < 30% perfusion defect, 3.2 (SD 2.9) in patients with 30 to 50% perfusion defect, and 5.3 (SD 3.7) in patients with > 50% perfusion defect. The area under the receiver operating characteristic curve for ECG score and those with > 50% perfusion defect was 0.71 (SE 0.04). An ECG score of >= 3 predicted those with > 50% perfusion defect with a sensitivity of 70% (95% confidence interval [CI], 59 to 81%), and a specificity of 59% (95% CI, 51 to 67%).

Conclusion: An ECG score, simple to derive, predicts those with the greatest percentage of perfusion defect. Using the ECG for management warrants prospective evaluation.

Key Words: ECG score • percentage perfusion defect • pulmonary embolism • severity assessment






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2004 by the American College of Chest Physicians.