Table 1
Author, date, countryPatient groupStudy typeOutcomesKey resultsStudy weaknesses
ECQ, electrocardiogram; LDH, lactate dehyrogenase; PE, pulmonary embolus
Rodger M et al, 2000, Canada212 consecutive patients referred for V/Q or pulmonary angiogram for suspected PEProspective validation of previously derived scoring systemPrevalence of 28 ECG abnormalities in those subsequently diagnosed as PE positive (49) or negative (163)Only 2 abnormalities (tachycardia and incomplete RBBB) significantly more prevalent in PE positive than PE negative patientsSmall numbers (possibility of false negative results)
Diagnostic utility of ECG scoring system (previously derived in patients diagnosed as PE positive) assessed for validationPositive and negative predictive values of scoring system 57.1 and 81.7, respectively
Stollberger C et al, 2000, Austria168 (derivation) and 139 (validation) inpatients suspected of PEProspective derivation/validation studyRisk factors, objective clinical signs, LDH, ECG (‘signs of right heart strain’), arterial blood gases, venography/plethysmography results and chest x ray recordedIndividual signs 16–48% sensitive for PE, 83–94% specificSmall sample size
Multivariate logistic regression established those associated with the diagnosis of PEPE score performance is reported for 17 different scores in paper. Examples are given below:Inpatient population only
‘PE score’ (including ECG signs of right heart strain) developed and validated in second groupPE score >0.3 Sn 100%, Sp 79%
PE Score >0.5 Sn 70%, Sp 99%
Miniati M et al, 2003, Italy1100 consecutive patients referred for investigation for PEDerivation/cross validation studyObjective signs, risk factors, ECG and CXR recorded. Multivariate logistic regression established those associated with the diagnosis of PEScoring system (included ECG signs of right heart strain) developed that divides patients into low, intermediate, moderately high, and high groupsSubjective inclusion criteria
Pre-test probability by groupNo prospective validation study (cross validation only
Low 4%
Intermediate 22%
Moderately high 74%
High 98%
Richman PB et al, 2004, USAPatients assessed for PE over 1 year. 49 with PE compared with 49 withoutObservationalECG changes classically associated with PESinus tachycardia (18.8% v 11.8%), incomplete RBBB (4.2% v 0%),Incomplete cohort used in that 252 patients investigated for PE were not used in analysis
S1Q3T3 (2.1% v 0%)
S1Q3 (0 v 0)
Sinha N et al, 2005, USAPatients undergoing CT pulmonary angiography at a tertiary hospital over 30 monthsRetrospective cohortECG changes significantly associated with PESinus tachycardia (39% v 24%)
S1Q3T3 (12% v 3%)
Atrial tachyarhythmias (15% v 4%)
Q3 (40% v 26%)
Q3T3 (8% v 1%)