Triaging acute pulmonary thrombo-embolic disease: Only a limited role for early warning scoring

Abstract

<b>Background/Objectives:</b> UK Emergency and Acute Departments are increasingly adopting triage and urgent call systems for a wide range of acute respiratory presentations with an over-reliance on the Early Warning Scoring (EWS) systems. The primary objective presently was to re-assess individual components and EWS scores in acute pulmonary thrombo-embolic disease (PTE). <b>Methods:</b> Data from 1700 acute presentations investigated by Computed Tomography Pulmonary Angiography (CTPA) over a 12 month period were analysed retrospectively. Data were also collected on vital signs at presentation. Comparative data were analysed using the MedCALC Statistics program. Results are reported comparing, respectively, outcomes from negative versus positive findings for PTE on CTPA. <b>Results:</b> 365 (21%) CTPA scans were abnormal for PTE; mean (SD, range) age of comparative groups did not differ significantly at 66.5 (17.4, 15-99) versus 68.8 (15.2, 23-102) years. D-Dimer scores were higher in the acute PTE group (mean 550 versus 796, p&lt;0.0001) but otherwise Heart Rate (87.5 versus 87.9/min), Respiratory Rate (18.2 versus 18.4/min), Systolic blood pressure (131.8 versus 132.2 mmHg) and EWS (2.36 versus 2.41) did not differ statistically. Oxygen saturation was also similar between groups (95.8 versus 95.5%) but where information was available (n=1065), 35.9% of those with negative CTPA and 25.7% positive scans were assessed on oxygen at admission. <b>Conclusions:</b> The presentation of acute PTE remains difficult with a large number of negative tests on CTPA. The vital signs at presentation and EWS do not help discriminate and at present can only have a limited role in triage.