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Abstract
A short cut review was carried out to establish the diagnostic utility of arterial blood gas analysis in patients with suspected pulmonary embolus. Altogether 459 papers were found using the reported search, of which six 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. A clinical bottom line is stated.
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Report by Margartet Maloba, Specialist Registrar Checked by Kerstin Hogg, Specialist Registrar
Clinical scenario
A 28 year old woman presents to the Emergency Department with acute suspected pulmonary embolus (PE). You wonder whether normal arterial blood gases are sufficient to rule out PE.
Three part question
In [patients with clinical diagnosis of PE] do [arterial blood gases] aid in [making a definite diagnosis]?
Search strategy
Medline OVID1966–2005 Feb week 1 and Embase OVID 1980–2005 week 7: (exp pulmonary embolism/OR pulmonary embolus.mp.) AND (exp embolism/OR embol$.mp. OR exp thromboembolism/OR thromboembol$.mp.) AND (exp blood gas analysis/OR arterial blood gas$.mp.)
Search outcome
Altogether 459 papers were found of which six directly addressed the question. These six papers are shown in table 3.
Comment(s)
Pulmonary angiography, the gold standard diagnostic tool in PE, has unacceptably high mortality and morbidity. At present, it cannot routinely be used in clinical practice. A reliable, cost effective, non-invasive test if identified would be of great use.
CLINICAL BOTTOM LINE
Arterial blood gas analysis alone is of limited diagnostic utility in suspected PE.
Report by Margartet Maloba, Specialist Registrar Checked by Kerstin Hogg, Specialist Registrar