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An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy.

Publication ,  Journal Article
Leung, AN; Bull, TM; Jaeschke, R; Lockwood, CJ; Boiselle, PM; Hurwitz, LM; James, AH; McCullough, LB; Menda, Y; Paidas, MJ; Royal, HD ...
Published in: Am J Respir Crit Care Med
November 15, 2011

BACKGROUND: Pulmonary embolism (PE) is a leading cause of maternal mortality in the developed world. Along with appropriate prophylaxis and therapy, prevention of death from PE in pregnancy requires a high index of clinical suspicion followed by a timely and accurate diagnostic approach. METHODS: To provide guidance on this important health issue, a multidisciplinary panel of major medical stakeholders was convened to develop evidence-based guidelines for evaluation of suspected pulmonary embolism in pregnancy using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. In formulation of the recommended diagnostic algorithm, the important outcomes were defined to be diagnostic accuracy and diagnostic yield; the panel placed a high value on minimizing cumulative radiation dose when determining the recommended sequence of tests. RESULTS: Overall, the quality of the underlying evidence for all recommendations was rated as very low or low, with some of the evidence considered for recommendations extrapolated from studies of the general population. Despite the low-quality evidence, strong recommendations were made for three specific scenarios: performance of chest radiography (CXR) as the first radiation-associated procedure; use of lung scintigraphy as the preferred test in the setting of a normal CXR; and performance of computed-tomographic pulmonary angiography (CTPA) rather than digital subtraction angiography (DSA) in a pregnant woman with a nondiagnostic ventilation-perfusion (V/Q) result. DISCUSSION: The recommendations presented in this guideline are based upon the currently available evidence; availability of new clinical research data and development and dissemination of new technologies will necessitate a revision and update.

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Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

November 15, 2011

Volume

184

Issue

10

Start / End Page

1200 / 1208

Location

United States

Related Subject Headings

  • Ultrasonography
  • Respiratory System
  • Radionuclide Imaging
  • Radiography, Thoracic
  • Radiation Dosage
  • Pulmonary Embolism
  • Pregnancy Complications, Cardiovascular
  • Pregnancy
  • Magnetic Resonance Imaging
  • Lung
 

Citation

APA
Chicago
ICMJE
MLA
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Leung, A. N., Bull, T. M., Jaeschke, R., Lockwood, C. J., Boiselle, P. M., Hurwitz, L. M., … ATS/STR Committee on Pulmonary Embolism in Pregnancy, . (2011). An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med, 184(10), 1200–1208. https://doi.org/10.1164/rccm.201108-1575ST
Leung, Ann N., Todd M. Bull, Roman Jaeschke, Charles J. Lockwood, Phillip M. Boiselle, Lynne M. Hurwitz, Andra H. James, et al. “An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy.Am J Respir Crit Care Med 184, no. 10 (November 15, 2011): 1200–1208. https://doi.org/10.1164/rccm.201108-1575ST.
Leung AN, Bull TM, Jaeschke R, Lockwood CJ, Boiselle PM, Hurwitz LM, et al. An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med. 2011 Nov 15;184(10):1200–8.
Leung, Ann N., et al. “An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy.Am J Respir Crit Care Med, vol. 184, no. 10, Nov. 2011, pp. 1200–08. Pubmed, doi:10.1164/rccm.201108-1575ST.
Leung AN, Bull TM, Jaeschke R, Lockwood CJ, Boiselle PM, Hurwitz LM, James AH, McCullough LB, Menda Y, Paidas MJ, Royal HD, Tapson VF, Winer-Muram HT, Chervenak FA, Cody DD, McNitt-Gray MF, Stave CD, Tuttle BD, ATS/STR Committee on Pulmonary Embolism in Pregnancy. An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med. 2011 Nov 15;184(10):1200–1208.

Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

November 15, 2011

Volume

184

Issue

10

Start / End Page

1200 / 1208

Location

United States

Related Subject Headings

  • Ultrasonography
  • Respiratory System
  • Radionuclide Imaging
  • Radiography, Thoracic
  • Radiation Dosage
  • Pulmonary Embolism
  • Pregnancy Complications, Cardiovascular
  • Pregnancy
  • Magnetic Resonance Imaging
  • Lung