Jeffry Kline is famous for his research on PE and his latest article in Academic Journal of Emergency Medicine(Jan 2012) is opening another window to PE regarding Normalization of Vital Signs Does Not Reduce the Probability of Acute Pulmonary Embolismin Symptomatic Emergency Department Patients.
This is a prospective, single-center study of diagnostic accuracy conducted on patients more than 17 yeras old presenting to an academic emergency department (ED), with at least one predefined symptom or sign of PE and one risk factor for PE. Four sets of vital signs were collected including pulse, respiratory rate, shock index, and pulse oximetry. 192 patients were enrolled and all of them had CTA, 35 (18%0 had PE. The prevalence of PE among patients with abnormal vital signs at triage which normalized later in ED are as following:
abnormal: Pulse: prevalences of PE 18%
abnormal: Respiratory rate: prevalences of PE 14%
abnormal: Shock index: prevalences of PE 19 %
abnormal: Pulse oximetry: prevalences of PE 33 %
and very important message is: if you have a patient with a sign or symptom and risk factor for pulmonary embolism, normalization of vital sign that was abnormal at triage is not a rationale to lower the pretest probability of pulmonary embolism in ED patients.