Abstract
Background Many patients have unexplained persistent dyspnea after negative computed tomographic pulmonary angiography (CTPA). We hypothesized that many of these patients have isolated right ventricular (RV) dysfunction from treatable causes. We previously derived a clinical decision rule (CDR) for predicting RV dysfunction consisting of persistent dyspnea and normal CTPA, finding that 53% of CDR-positive patients had isolated RV dysfunction. Our goal is to validate this previously derived CDR by measuring the prevalence of RV dysfunction and outcomes in dyspneic emergency department patients. Methods A secondary analysis of a prospective observational multicenter study that enrolled patients presenting with suspected PE was performed. We included patients with persistent dyspnea, a nonsignificant CTPA, and formal echo performed. Right ventricular dysfunction was defined as RV hypokinesis and/or dilation with or without moderate to severe tricuspid regurgitation. Results A total of 7940 patients were enrolled. Two thousand six hundred sixteen patients were analyzed after excluding patients without persistent dyspnea and those with a significant finding on CTPA. One hundred ninety eight patients had echocardiography performed as standard care. Of those, 19% (95% confidence interval [CI], 14%-25%) and 33% (95% CI, 25%-42%) exhibited RV dysfunction and isolated RV dysfunction, respectively. Patients with isolated RV dysfunction or overload were more likely than those without RV dysfunction to have a return visit to the emergency department within 45 days for the same complaint (39% vs 18%; 95% CI of the difference, 4%-38%). Conclusion This simple clinical prediction rule predicted a 33% prevalence of isolated RV dysfunction or overload. Patients with isolated RV dysfunction had higher recidivism rates and a trend toward worse outcomes.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 542-547 |
| Number of pages | 6 |
| Journal | American Journal of Emergency Medicine |
| Volume | 33 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2015 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Emergency Medicine
Cite this
Independent evaluation of a simple clinical prediction rule to identify right ventricular dysfunction in patients with shortness of breath. / Russell, Frances M.; Moore, Christopher L.; Courtney, D. Mark; Kabrhel, Christopher; Smithline, Howard A.; Nordenholz, Kristen E.; Richman, Peter B.; O'Neil, Brian J.; Plewa, Michael C.; Beam, Daren M.; Mastouri, Ronald; Kline, Jeffrey A.
In: American Journal of Emergency Medicine, Vol. 33, No. 4, 01.04.2015, p. 542-547.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Independent evaluation of a simple clinical prediction rule to identify right ventricular dysfunction in patients with shortness of breath
AU - Russell, Frances M.
AU - Moore, Christopher L.
AU - Courtney, D. Mark
AU - Kabrhel, Christopher
AU - Smithline, Howard A.
AU - Nordenholz, Kristen E.
AU - Richman, Peter B.
AU - O'Neil, Brian J.
AU - Plewa, Michael C.
AU - Beam, Daren M.
AU - Mastouri, Ronald
AU - Kline, Jeffrey A.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Background Many patients have unexplained persistent dyspnea after negative computed tomographic pulmonary angiography (CTPA). We hypothesized that many of these patients have isolated right ventricular (RV) dysfunction from treatable causes. We previously derived a clinical decision rule (CDR) for predicting RV dysfunction consisting of persistent dyspnea and normal CTPA, finding that 53% of CDR-positive patients had isolated RV dysfunction. Our goal is to validate this previously derived CDR by measuring the prevalence of RV dysfunction and outcomes in dyspneic emergency department patients. Methods A secondary analysis of a prospective observational multicenter study that enrolled patients presenting with suspected PE was performed. We included patients with persistent dyspnea, a nonsignificant CTPA, and formal echo performed. Right ventricular dysfunction was defined as RV hypokinesis and/or dilation with or without moderate to severe tricuspid regurgitation. Results A total of 7940 patients were enrolled. Two thousand six hundred sixteen patients were analyzed after excluding patients without persistent dyspnea and those with a significant finding on CTPA. One hundred ninety eight patients had echocardiography performed as standard care. Of those, 19% (95% confidence interval [CI], 14%-25%) and 33% (95% CI, 25%-42%) exhibited RV dysfunction and isolated RV dysfunction, respectively. Patients with isolated RV dysfunction or overload were more likely than those without RV dysfunction to have a return visit to the emergency department within 45 days for the same complaint (39% vs 18%; 95% CI of the difference, 4%-38%). Conclusion This simple clinical prediction rule predicted a 33% prevalence of isolated RV dysfunction or overload. Patients with isolated RV dysfunction had higher recidivism rates and a trend toward worse outcomes.
AB - Background Many patients have unexplained persistent dyspnea after negative computed tomographic pulmonary angiography (CTPA). We hypothesized that many of these patients have isolated right ventricular (RV) dysfunction from treatable causes. We previously derived a clinical decision rule (CDR) for predicting RV dysfunction consisting of persistent dyspnea and normal CTPA, finding that 53% of CDR-positive patients had isolated RV dysfunction. Our goal is to validate this previously derived CDR by measuring the prevalence of RV dysfunction and outcomes in dyspneic emergency department patients. Methods A secondary analysis of a prospective observational multicenter study that enrolled patients presenting with suspected PE was performed. We included patients with persistent dyspnea, a nonsignificant CTPA, and formal echo performed. Right ventricular dysfunction was defined as RV hypokinesis and/or dilation with or without moderate to severe tricuspid regurgitation. Results A total of 7940 patients were enrolled. Two thousand six hundred sixteen patients were analyzed after excluding patients without persistent dyspnea and those with a significant finding on CTPA. One hundred ninety eight patients had echocardiography performed as standard care. Of those, 19% (95% confidence interval [CI], 14%-25%) and 33% (95% CI, 25%-42%) exhibited RV dysfunction and isolated RV dysfunction, respectively. Patients with isolated RV dysfunction or overload were more likely than those without RV dysfunction to have a return visit to the emergency department within 45 days for the same complaint (39% vs 18%; 95% CI of the difference, 4%-38%). Conclusion This simple clinical prediction rule predicted a 33% prevalence of isolated RV dysfunction or overload. Patients with isolated RV dysfunction had higher recidivism rates and a trend toward worse outcomes.
UR - http://www.scopus.com/inward/record.url?scp=84928211491&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84928211491&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2015.01.026
DO - 10.1016/j.ajem.2015.01.026
M3 - Article
C2 - 25769797
AN - SCOPUS:84928211491
VL - 33
SP - 542
EP - 547
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
IS - 4
ER -