Evidence map›Paper›PMID 36826504›Full record

ArticleEuropean radiology2023

Strategies to safely rule out pulmonary embolism in COVID-19 outpatients: a multicenter retrospective study.

Guillaume Chassagnon, Mostafa El Hajjam, Samia Boussouar, Marie-Pierre Revel, Ralph Khoury, Benoît Ghaye, Sebastien Bommart, Mathieu Lederlin, Stephane Tran Ba, Constance De Margerie-Mellon and 32 more

Open access · bronzeAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European radiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.1field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 4 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

42 authors at 13 institutions in 2 countries.

Guillaume ChassagnonRadiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France. guillaume.chassagnon@aphp.fr.ORCID http://orcid.org/0000-0003-1487-7922
Mostafa El HajjamRadiology Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France.
Samia BoussouarCardiothoracic Imaging Unit, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne UniversitéLaboratoire d'imagerie Biomédicale, INSERM, ICAN Institute of Cardiometabolism and Nutrition, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
Marie-Pierre RevelRadiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
Ralph KhouryRadiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France.
Benoît GhayeRadiology Department, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium.
Sebastien BommartRadiology Department, Hôpital Arnaud de Villeneuve, PHYMEDEXP - INSERM U1046 - CNRS UMR 9214, Université de Montpellier, 371 Avenue Doyen Gaston Giraud, 34090, Montpellier, France.
Mathieu LederlinRadiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France.
Stephane Tran BaRadiology Department, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France.
Constance De Margerie-MellonRadiology Department, Hôpital Saint-Louis, AP-HP, Université Paris Cité, 1 Avenue Claude Vellefaux, 75010, Paris, France.
Laure FournierRadiology Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France.
Lucie CassagnesRadiology Department, CHU Gabriel Montpied, Institut Pascal, TGI, UMR6602 CNRS SIGMA UCA, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France.
Mickael OhanaRadiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France.
Carole JalaberRadiology Department, CHU Saint Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
Gael DournesDepartment of Cardio-Thoracic Imaging, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, 1 Avenue Magellan, 33600, Pessac, France.
Nicolas CazeneuveRadiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France.
Gilbert FerrettiRadiology Department, CHU de Grenoble Alpes, Université Grenoble Alpes, avenue des Maquis du Grésivaudan, 38700 La Tronche, 38043, Grenoble, France.
Pauline TalabardRadiology Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France.
Victoria DonciuRadiology Department, Hôpital Pitié Salpêtrière, AP-HP, Sorbonne Université 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
Emma CanniffRadiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
Marie-Pierre DebrayRadiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France.
Bernard CrutzenRadiology Department, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium.
Jeremy CharriotPulmonology Department, Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 Avenue Doyen Gaston Giraud, 34090, Montpellier, France.
Valentin RabeauRadiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France.
Philippe KhafagyRadiology Department, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France.
Richard ChocronEmergency Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France.
Ian Leonard LorantRadiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France.
Loic MetairyRadiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France.
Lea Ruez-LantuejoulRadiology Department, CHU de Grenoble Alpes, Université Grenoble Alpes, avenue des Maquis du Grésivaudan, 38700 La Tronche, 38043, Grenoble, France.
Sébastien BeauneEmergency Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
Pierre HausfaterEmergency Department, Hôpital Pitié Salpêtrière, AP-HP, GRC-14 BIOSFAST Sorbonne Université, UMR INSERM 1166, IHU ICAN, Sorbonne Université, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
Jennifer TruchotEmergency Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
Antoine KhalilRadiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France.
Andrea PenalozaServices Des Urgences, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium.
Thibaut AffoleRadiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France.
Pierre-Yves BrilletRadiology Department, Hôpital Avicenne, AP-HP, UMR U1272 Hypoxie Et Poumon INSERM, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France.
Catherine RoyRadiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France.
Julien PucheuxRadiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France.
Jordan ZbiliRadiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France.
Olivier SanchezPulmonology Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France.
Raphael PorcherCenter for Clinical Epidemiology, Hôtel Dieu, AP-HP, Université Paris Cité, 1 Place du Parvis de, 75004, Paris, France.
on the behalf of the French Society of Thoracic Imaging
Université Paris Cité · FRHôpital Pontchaillou · FRCentre Hospitalier Universitaire de Tours · FRCliniques Universitaires Saint-Luc · BEHôpital Civil, Strasbourg · FRInserm · FRSorbonne Université · FRUniversité Paris-Saclay · FRCentre Hospitalier Universitaire de Grenoble · FRCentre National de la Recherche Scientifique · FRHôpital Arnaud de Villeneuve · FRInstitute Cancer De La Loire Lucien Neuwirth · FRUniversité de Bordeaux · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe objective was to define a safe strategy to exclude pulmonary embolism (PE) in COVID-19 outpatients, without performing CT pulmonary angiogram (CTPA).

methodsCOVID-19 outpatients from 15 university hospitals who underwent a CTPA were retrospectively evaluated. D-Dimers, variables of the revised Geneva and Wells scores, as well as laboratory findings and clinical characteristics related to COVID-19 pneumonia, were collected. CTPA reports were reviewed for the presence of PE and the extent of COVID-19 disease. PE rule-out strategies were based solely on D-Dimer tests using different thresholds, the revised Geneva and Wells scores, and a COVID-19 PE prediction model built on our dataset were compared. The area under the receiver operating characteristics curve (AUC), failure rate, and efficiency were calculated.

resultsIn total, 1369 patients were included of whom 124 were PE positive (9.1%). Failure rate and efficiency of D-Dimer > 500 µg/l were 0.9% (95%CI, 0.2-4.8%) and 10.1% (8.5-11.9%), respectively, increasing to 1.0% (0.2-5.3%) and 16.4% (14.4-18.7%), respectively, for an age-adjusted D-Dimer level. D-dimer > 1000 µg/l led to an unacceptable failure rate to 8.1% (4.4-14.5%). The best performances of the revised Geneva and Wells scores were obtained using the age-adjusted D-Dimer level. They had the same failure rate of 1.0% (0.2-5.3%) for efficiency of 16.8% (14.7-19.1%), and 16.9% (14.8-19.2%) respectively. The developed COVID-19 PE prediction model had an AUC of 0.609 (0.594-0.623) with an efficiency of 20.5% (18.4-22.8%) when its failure was set to 0.8%.

conclusionsThe strategy to safely exclude PE in COVID-19 outpatients should not differ from that used in non-COVID-19 patients. The added value of the COVID-19 PE prediction model is minor. KEY POINTS: • D-dimer level remains the most important predictor of pulmonary embolism in COVID-19 patients. • The AUCs of the revised Geneva and Wells scores using an age-adjusted D-dimer threshold were 0.587 (95%CI, 0.572 to 0.603) and 0.588 (95%CI, 0.572 to 0.603). • The AUC of COVID-19-specific strategy to rule out pulmonary embolism ranged from 0.513 (95%CI: 0.503 to 0.522) to 0.609 (95%CI: 0.594 to 0.623).

Indexed as

COVID-19Pulmonary EmbolismHumansOutpatientsRetrospective StudiesROC CurveComputed tomography angiographyCOVID-19Pulmonary embolism

Identifiers

PMID36826504
PMCPMC9951833
OpenAlexW4321749320

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