Diagnosis of Pulmonary Embolism in patients with Hemoptysis: the POPEIHE study

Abstract

To determine the prevalence and characteristics of pulmonary embolism (PE) in patients presenting with hemoptysis. Additionally, we assessed the efficiency and failure rates of different clinical diagnostic algorithms for PE in this patient population.We enrolled consecutive adult patients who presented to nine Italian Emergency Departments (ED) with hemoptysis as the primary complaint. PE diagnosis was ruled out in patients with a low pretest probability in combination with a negative age-adjusted D-dimer (referred to as the “age-adjusted” D-dimer strategy), a negative computed tomography pulmonary angiography, or when a clear alternative source of bleeding was identified, along with negative findings for venous thromboembolism during a 30-day follow-up.A total of 546 patients were included in the study. The prevalence of PE, including the 30-day follow-up, was 4.2% (95% confidence interval, CI, 2.7–6.3%). The majority of these cases (78%) exhibited distal (segmental or subsegmental) emboli, and there were no PE-related fatalities. The “age-adjusted” D-dimer strategy initially excluded PE in 24% of patients (95% CI, 21–28%), with a failure rate of 0.8% (95% CI, 0.0–4.1%). Retrospectively applied, the “clinical probability-adjusted” D-dimer strategies, specifically the YEARS and PEGeD algorithms, excluded PE in a significantly higher proportion (30% and 32%, respectively) compared to the “age-adjusted” D-dimer strategy (p<0.05 for both), with similar failure rates.Pulmonary embolism is infrequent among patients presenting with hemoptysis, showing segmental or subsegmental emboli distribution. The “clinical probability-adjusted” D-dimer strategies seem to have significantly higher efficiency compared to the “age-adjusted” strategy.