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abstract
Objectives: The prompt diagnosis of postoperative
pulmonary embolism (PE) in gynecologic oncology patients is imperative,
but the clinical presentation is nonspecific in this high-risk group. We
sought to determine risk factors and clinical findings that may assist
clinicians in diagnosing PE in the inpatient setting.
Methods: Radiology data were queried to identify
patients with gynecologic cancer who had a postoperative PE evaluation
with computed tomography pulmonary angiography (CT-PA). Patient clinical
findings at the time of the PE evaluation were abstracted, and
univariate and multivariate regression analyses were performed to
identify predictors of PE.
Results: For 6 years, there were 2498 major
gynecologic oncology surgical procedures performed at our institution.
Within 14 days of surgery, 107 CT-PA studies were obtained with a
positive study rate of 24.3%. In patients with and without PE, there was
no significant difference noted for age, oxygen saturations, body mass
index and heart rate. After controlling for stage, history of venous
thromboembolism (VTE), heart rate, and oxygen saturation, platelet count and history of VTE (odds ratio, were identified as independent predictors of PE in the multivariate model.
Conclusions: Although clinicians often use tachycardia
and low oxygen saturation as triggers to order PE imaging studies,
these signs have a very low specificity. Given the findings of our
study, accounting for high platelet count and history of VTE increases
the pretest probability of CT-PA study.
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