Diagnosis of Pulmonary Embolism During Pregnancy
Authors: Steve Goodacre, Beverley Hunt, Catherine Nelson-Piercy
Journal: Annals of Internal Medicine (2019)

Letters16 July 2019Diagnosis of Pulmonary Embolism During PregnancySteve Goodacre, PhD, Beverley Hunt, PhD, and Catherine Nelson-Piercy, PhDSteve Goodacre, PhDSchool of Health and Related Research, University of Sheffield, Sheffield, United Kingdom (S.G.), Beverley Hunt, PhDGuy's and St Thomas's NHS Foundation Trust, London, United Kingdom (B.H., C.N.), and Catherine Nelson-Piercy, PhDGuy's and St Thomas's NHS Foundation Trust, London, United Kingdom (B.H., C.N.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0190 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Righini and colleagues (1) conclude that a diagnostic strategy based on assessment of clinical probability, D-dimer testing, compression ultrasonography, and computed tomography pulmonary angiography can safely exclude pulmonary embolism (PE) in pregnant women. Our recent, larger study—Diagnosis of PE in Pregnancy (DiPEP)—challenges this conclusion.The DiPEP study evaluated clinical probability scores (modified for pregnancy) and D-dimer assays in 181 pregnant or postpartum women with PE that was confirmed by imaging or autopsy and 259 pregnant or postpartum women in whom PE was excluded after imaging (2). All the clinical probability scores had poor discriminant value for PE. ...References1. Righini M, Robert-Ebadi H, Elias A, et al; CT-PE-Pregnancy Group. Diagnosis of pulmonary embolism during pregnancy. A multicenter prospective management outcome study. Ann Intern Med. 2018;169:766-73. [PMID: 30357273]. doi:10.7326/M18-1670 LinkGoogle Scholar2. Goodacre S, Horspool K, Nelson-Piercy C, et al; DiPEP research group. The DiPEP study: an observational study of the diagnostic accuracy of clinical assessment, D-dimer and chest x-ray for suspected pulmonary embolism in pregnancy and postpartum. BJOG. 2019;126:383-92. [PMID: 29782079] doi:10.1111/1471-0528.15286 CrossrefMedlineGoogle Scholar3. Goodacre S, Horspool K, Shephard N, et al. Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling. Health Technol Assess. 2018;22:1-230. [PMID: 30178738] doi:10.3310/hta22470 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom (S.G.)Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom (B.H., C.N.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0190. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnosis of Pulmonary Embolism During Pregnancy Marc Righini , Helia Robert-Ebadi , Antoine Elias , Olivier Sanchez , Emmanuelle Le Moigne , Jeannot Schmidt , Catherine Le Gall , Jacques Cornuz , Drahomir Aujesky , Pierre-Marie Roy , Céline Chauleur , Olivier T. Rutschmann , Pierre-Alexandre Poletti , Grégoire Le Gal , and Diagnosis of Pulmonary Embolism During Pregnancy Stephen Malnick and Lucy Kikayon Diagnosis of Pulmonary Embolism During Pregnancy Marc Righini and Grégoire Le Gal Metrics Cited byVenous thrombosis risk factors in pregnant women 16 July 2019Volume 171, Issue 2Page: 146-147KeywordsAutopsyComputed axial tomographyD-dimerDecision analysisDisclosurePregnancyPulmonary embolismQuality adjusted life yearsSpecificityUltrasound imaging ePublished: 16 July 2019 Issue Published: 16 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...