S M Wazien Wafa S Saadun Tarek Wafa, Mohammad Zikri Ahmad, Mohd Boniami Yazid, Mohd Hashairi Fauzi, Shaik Farid Abdull Wahab, Nafisah Idris

AIM

Pleuritic chest pain is a common presentation in ED and it could sometimes be related to pleural irritation due to pulmonary infarct in pulmonary embolism (PE).

Lung ultrasound (LUS) can detect pulmonary infarct, however its diagnostic accuracy for PE in a selected population presenting with pleuritic chest pain is unknown.

The aim of the study is to analyze the performance of LUS in the diagnosis of PE in patients complaining of pleuritic chest pain.

METHODS

We combined individual patient data from three prospective cohort studies (one monocentric and two multicentric) involving patients evaluated for suspected PE in which LUS was performed at presentation.

We extrapolated data regarding patients with and without pleuritic pain, and re-assessed the performance of LUS in the two populations for comparison.

RESULTS

Among the 872 patients suspected of PE considered in the three studies,

217 (24.9%) presented with pleuritic chest pain.

Overall, 279 patients (32%) were diagnosed with PE.

Pooled sensitivity of LUS in patients with and without pleuritic pain was respectively 81.5% (95%CI 70-90.1%) and 49.5% (95%CI 42.7-56.4%) (p <0.001).

Specificity of LUS was similar in the two groups, respectively 95.4% (95%CI 90.7-98.1%) and 94.8% (95%CI 92.3-97.7%) (p=0.86).

In patients with pleuritic pain, a diagnostic strategy combining Wells score with LUS performed better in terms of sensitivity (93%, 95%CI 80.9-98.5% vs 90.7%, 95%CI 77.9-97.4%), negative predictive value (96.2%, 95%CI 89.6-98.7% vs 93.3%, 95%CI 84.4-97.3%).

Efficiency of Wells score/LUS was significantly superior to the conventional strategy based on Wells score/D-Dimer (56.7%, 95%CI 48.5-65% vs 42.5%, 95%CI 34.3-51.2%).

CONCLUSION

In a population of patients suspected for PE, LUS for PE showed better sensitivity when applied to the subgroup complaining of pleuritic chest pain.

In these patients, a diagnostic strategy based on Wells score and LUS performs better to exclude PE than the conventional rule based on clinical scoring and D-Dimer.