Thursday, February 9, 2017

Vital Signs and PE

R.E:B.E:L.EM - By Beck-Esmay J - February 9, 2017
..."Clinical Question:
Does the normalization of initially abnormal vital signs change to probability of pulmonary embolism in symptomatic patients being evaluated for pulmonary embolism in the emergency department?...
Author’s Conclusions:
“Clinicians should not use the observation of normalized vital signs as a reason to forego objective testing for symptomatic patients with a risk factor for PE.”
Our Conclusions:
If you have a patient in whom you suspect PE, the normalization of their vital signs during their time in the ED should not reassure you that they do not have a PE.
Potential Impact To Current Practice:
This study suggests that when formulating clinical gestalt or when applying vital signs to a clinical decision making rule, the most abnormal vital sign should be used.
Clinical Bottom Line:
For patients in whom you suspect PE, normalization of vital signs should not be used as a rationale to lower your pretest probability for the disease. The best approach is to use the most abnormal vital sign measurement when determining the pre-test probability of a PE in the patient."