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Diagnostic utility of electrocardiogram for diagnosing pulmonary embolism
  1. Ged Brown, Specialist Registrar,
  2. Kerstin Hogg
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A shortcut review was carried out to establish the diagnostic utility of electrocardiography in patients with suspected pulmonary embolus (PE). Altogether 952 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated (table 1). It is concluded that although there are electrocardiogram (ECG) changes that are more common in PE, the ECG alone is not sufficiently sensitive or specific to rule out or rule in the diagnosis.

    • ECG
    • electrocardiography
    • pulmonary embolism
    • embolus
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    Clinical scenario

    A 30 year old man presents to the emergency department with a spontaneous onset of atraumatic pleuritic chest pain. He is in a low risk group clinically. The medical registrar suggests that the fact that the ECG is normal makes the diagnosis of PE much less likely. You wonder whether his assertion that a normal ECG will help to exclude a PE is safe.

    Three part question

    In [a patient presenting with features suggestive of pulmonary embolus] what is [the diagnostic utility of ECG] in [stratifying risk of pulmonary embolus]?

    Search strategy

    Medline OVID 1966 to week 4 June 2005 [exp Pulmonary Embolism OR exp THROMBOEMBOLISM OR PE.mp OR pulmonary infarct$.mp OR Pulmonary Embol$.mp] AND [exp Electrocardiography OR Electrocardio$.mp OR ECG.mp OR EKG.mp]. LIMIT to human AND English. The Cochrane Library Issue 1 2005.

    [{Pulmonary embolism MeSH OR thromboembolism MeSH}] AND [{electrocardiography MeSH}].

    Search outcome

    Altogether 952 papers were found of which 947 were not directly relevant to the question, were of insufficient quality, or did not report enough data to assess the diagnostic utility of ECG or a scoring system in which it was included. The remaining papers are summarised in the table below.

    Comments

    Although it is clear that there are some ECG changes that occur more frequently in patients with PE, these occur infrequently. There is no evidence that an ECG alone has adequate sensitivity or specificity to rule out or in a PE. It may have utility as part of risk stratification strategies.

    CLINICAL BOTTOM LINE

    An ECG alone is of little value in the diagnosis of PE. Its main value is in ruling out other causes of the presenting symptoms, or as part of a risk stratification strategy to inform a further investigative protocol.

    Table 1

    References

    View Abstract

    Footnotes

    • Report by Ged Brown, Specialist RegistrarSearch checked by Kerstin Hogg, Clinical Research Fellow

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