Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts.
Paul L. den Exter
(1)
,
Lucia J. M. Kroft
(1)
,
Carole Gonsalves
(2)
,
Grégoire Le Gal
(2)
,
Cornelia M. Schaefer-Prokop
(3)
,
Marc Carrier
(2)
,
Menno V. Huisman
(1)
,
Frederikus A. Klok
(1)
,
L. Meijboom
(4)
,
L. F. Beenen
(5)
,
A. de Roos
(1)
,
I. Hartmann
(6)
,
C. Dennie
(2)
,
M. P. Revel
(7)
,
L. Haramati
,
E. van Beek
,
N. Screaton
,
G. Ferretti
(8)
,
B. Ghaye
(9)
,
M. Das
,
C. White
(10)
,
E. Pena Fernandez
(2)
,
N. Paul
(11)
,
I. Vlahos
(12)
,
R. D. Renapurkar
(13)
,
J. Ravenel
(14)
,
J. Kanne
(15)
,
S. Abbara
,
Martine Remy
(16)
,
B. Geurts
(3)
,
T. Frauenfelder
(17)
,
N. Sverzellati
(18)
,
H. Prosch
(19)
,
J. M. Goo
(20)
,
J. Vogel-Claussen
(21)
,
P. J. Macmahon
(22)
,
S. Bhalla
(23)
,
S. Kahn
(24)
,
S. Shivakumar
(25)
,
P. Wells
(2)
,
M. Rodger
(2)
,
L. Castellucci
(2)
,
L. Duffett
(2)
,
A. Delluc
(2)
,
D. Siegal
(26)
,
A. Lazo-Langner
(27)
,
C. Wu
(28)
,
A. Lee
(29)
,
D. Garcia
(23)
,
J. Zwicker
(30)
,
D. Aujesky
(31)
,
D. Jimenez
,
M. Righini
(32)
,
M. Blondon
(33)
,
C. Ay
(19)
,
S. Barco
(34)
,
P. W. Kamphuisen
,
M. Ferreira
(35)
,
O. Sanchez
(36)
,
L. K. Moores
,
C. Tromeur
(37)
,
W. Ageno
(38)
,
B. Hunt
(39)
,
P. Prandoni
(40)
,
M. Monreal
,
P. M. Roy
(41)
,
I. Pabinger
(19)
,
M. P. Donadini
,
F. Moustafa
(42)
,
L. Jara-Palomares
(43)
,
R. Pedroc
,
L. Bertoletti
,
P. Verhamme
(44)
,
H. Eikenboom
(1)
,
F. van der Meer
(1)
,
H. R. Büller
(5)
,
N. van Es
(5)
1
LUMC -
Leiden University Medical Center
2 University of Ottawa [Ottawa]
3 Radboud University Medical Center [Nijmegen]
4 VU University Medical Center [Amsterdam]
5 Amsterdam UMC - Amsterdam University Medical Center
6 Maasstad Ziekenhuis = Maasstad Hospital
7 Hôpital Cochin [AP-HP]
8 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
9 Cliniques Universitaires Saint-Luc [Bruxelles]
10 University of Maryland [Baltimore]
11 University of Toronto
12 St George’s University Hospitals
13 Cleveland Clinic
14 MUSC - Medical University of South Carolina [Charleston]
15 University of Wisconsin School of Medicine and Public Health
16 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
17 UZH - Universität Zürich [Zürich] = University of Zurich
18 UNIPR - Università degli studi di Parma = University of Parma
19 Medizinische Universität Wien = Medical University of Vienna
20 SNU - Seoul National University [Seoul]
21 MHH - Medizinische Hochschule Hannover = Hannover Medical School
22 UCD - University College Dublin [Dublin]
23 Washington University School of Medicine [Saint Louis, MO]
24 McGill University = Université McGill [Montréal, Canada]
25 Dalhousie University [Halifax]
26 McMaster University [Hamilton, Ontario]
27 UWO - University of Western Ontario
28 University of Alberta
29 SPH-UBC - St. Paul’s Hospital - University of British Columbia [Vancouver, BC, Canada]
30 Harvard University
31 UNIL - Université de Lausanne = University of Lausanne
32 HUG - Hôpitaux Universitaires de Genève
33 HUG - Hôpitaux universitaires de Genève = University Hospitals of Geneva
34 University Medical Center [Mainz]
35 EPE - Hospital Garcia de Orta
36 HEGP - Hôpital Européen Georges Pompidou [APHP]
37 CHU - BREST - Hôpital de la Cavale Blanche - CHRU Brest
38 Uninsubria - Universitá degli Studi dell’Insubria = University of Insubria [Varese]
39 Guy's and St Thomas' NHS Foundation Trust
40 Unipd - Università degli Studi di Padova = University of Padua
41 CHU Angers - Centre Hospitalier Universitaire d'Angers
42 UCA [2017-2020] - Université Clermont Auvergne [2017-2020]
43 Hospital Universitario Virgen del Rocío [Sevilla]
44 UZ Leuven - Universitair Ziekenhuis Leuven
2 University of Ottawa [Ottawa]
3 Radboud University Medical Center [Nijmegen]
4 VU University Medical Center [Amsterdam]
5 Amsterdam UMC - Amsterdam University Medical Center
6 Maasstad Ziekenhuis = Maasstad Hospital
7 Hôpital Cochin [AP-HP]
8 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
9 Cliniques Universitaires Saint-Luc [Bruxelles]
10 University of Maryland [Baltimore]
11 University of Toronto
12 St George’s University Hospitals
13 Cleveland Clinic
14 MUSC - Medical University of South Carolina [Charleston]
15 University of Wisconsin School of Medicine and Public Health
16 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
17 UZH - Universität Zürich [Zürich] = University of Zurich
18 UNIPR - Università degli studi di Parma = University of Parma
19 Medizinische Universität Wien = Medical University of Vienna
20 SNU - Seoul National University [Seoul]
21 MHH - Medizinische Hochschule Hannover = Hannover Medical School
22 UCD - University College Dublin [Dublin]
23 Washington University School of Medicine [Saint Louis, MO]
24 McGill University = Université McGill [Montréal, Canada]
25 Dalhousie University [Halifax]
26 McMaster University [Hamilton, Ontario]
27 UWO - University of Western Ontario
28 University of Alberta
29 SPH-UBC - St. Paul’s Hospital - University of British Columbia [Vancouver, BC, Canada]
30 Harvard University
31 UNIL - Université de Lausanne = University of Lausanne
32 HUG - Hôpitaux Universitaires de Genève
33 HUG - Hôpitaux universitaires de Genève = University Hospitals of Geneva
34 University Medical Center [Mainz]
35 EPE - Hospital Garcia de Orta
36 HEGP - Hôpital Européen Georges Pompidou [APHP]
37 CHU - BREST - Hôpital de la Cavale Blanche - CHRU Brest
38 Uninsubria - Universitá degli Studi dell’Insubria = University of Insubria [Varese]
39 Guy's and St Thomas' NHS Foundation Trust
40 Unipd - Università degli Studi di Padova = University of Padua
41 CHU Angers - Centre Hospitalier Universitaire d'Angers
42 UCA [2017-2020] - Université Clermont Auvergne [2017-2020]
43 Hospital Universitario Virgen del Rocío [Sevilla]
44 UZ Leuven - Universitair Ziekenhuis Leuven
L. Haramati
- Fonction : Auteur
E. van Beek
- Fonction : Auteur
N. Screaton
- Fonction : Auteur
M. Das
- Fonction : Auteur
S. Abbara
- Fonction : Auteur
D. Jimenez
- Fonction : Auteur
P. W. Kamphuisen
- Fonction : Auteur
L. K. Moores
- Fonction : Auteur
M. Monreal
- Fonction : Auteur
M. P. Donadini
- Fonction : Auteur
R. Pedroc
- Fonction : Auteur
L. Bertoletti
- Fonction : Auteur
Résumé
Background
Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria.
Objectives
We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus.
Methods
Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%.
Results
Twenty‐nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of ≤1 mm. These criteria were approved by 83% of the clinical venous thromboembolism (VTE) specialists. The clinical expert panel favored anticoagulant treatment in case of prior VTE, antiphospholipid syndrome, pregnancy, cancer, and proximal deep vein thrombosis.
Conclusion
The results of this analysis provide standard radiological criteria for ssPE that may be applicable in both clinical trials and practice.
| Origine | Fichiers produits par l'(les) auteur(s) |
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