Nicole F Morris, Rasha Georgie, Christine L D'Arsigny, Paula James, Sameer Parpia, Federico Germini, Natasha Clayton, David Good, Kerstin de Wit
{"title":"调整-不可能肺栓塞测试使用电话招募:一项试点研究,以评估其安全性和有效性的可行性。","authors":"Nicole F Morris, Rasha Georgie, Christine L D'Arsigny, Paula James, Sameer Parpia, Federico Germini, Natasha Clayton, David Good, Kerstin de Wit","doi":"10.1136/emermed-2024-214465","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Studies on pulmonary embolism (PE) rule-out strategies traditionally recruited patients in the ED. This method is increasingly impractical given excessive pressures experienced in EDs. Attempting to reach patients after leaving the ED may be more feasible. The aim of this study was to assess the feasibility of recruiting and following patients for an ED PE testing study by telephone.</p><p><strong>Methods: </strong>This was a prospective pilot study conducted in one ED and one urgent care centre in Ontario, Canada. Adult patients tested for PE using Adjust-Unlikely (a simple decision rule combining Gestalt with age-adjusted D-dimer) were called for consent after leaving the ED. Patients were followed for 90 days by medical record review plus telephone, text or email to identify subsequent venous thromboembolism testing. Venous thromboembolism events were independently adjudicated. Feasibility outcomes were recruitment rate, missed eligible rate and follow-up rate. Progression criteria were a recruitment rate of at least five participants per site, per week, a missed eligible rate of no more than two patients per site, per week, and a follow-up rate of at least 90% of enrolled patients.</p><p><strong>Results: </strong>684 patients were tested for PE between 24 March and 10 June 2023. A total of 210 patients were excluded. From 474 eligible patients, 200 were recruited. Median age was 58 years, 72.2% were female, and 3.5% were diagnosed with PE on index visit. Median recruitment rate was 7 participants per site, per week (first-third quartile (Q1-Q3), 4-14) and median missed eligible rate was 6 patients per site, per week (Q1-Q3, 3-8). After 90 days, 2 participants withdrew and 191/198 (96.5%, 95% CI 92.9, 98.3%) were contacted in follow-up. 143/198 (72.2%, 95% CI 65.6, 78.0%) participants did not require pulmonary imaging because PE was excluded by Adjust-Unlikely. 1/143 (0.7%, 95% CI 0.1, 3.9%) of these participants was diagnosed with PE in the segmental pulmonary arteries during follow-up.</p><p><strong>Conclusions: </strong>Telephone recruitment did not meet predefined feasibility thresholds as the missed eligible rate was high. However, the recruitment rate was higher than in previous studies, and there was minimal loss to follow-up.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"496-502"},"PeriodicalIF":2.7000,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Adjust-Unlikely pulmonary embolism testing using telephone recruitment: a pilot study to assess the feasibility of evaluating its safety and efficiency.\",\"authors\":\"Nicole F Morris, Rasha Georgie, Christine L D'Arsigny, Paula James, Sameer Parpia, Federico Germini, Natasha Clayton, David Good, Kerstin de Wit\",\"doi\":\"10.1136/emermed-2024-214465\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Studies on pulmonary embolism (PE) rule-out strategies traditionally recruited patients in the ED. This method is increasingly impractical given excessive pressures experienced in EDs. Attempting to reach patients after leaving the ED may be more feasible. The aim of this study was to assess the feasibility of recruiting and following patients for an ED PE testing study by telephone.</p><p><strong>Methods: </strong>This was a prospective pilot study conducted in one ED and one urgent care centre in Ontario, Canada. Adult patients tested for PE using Adjust-Unlikely (a simple decision rule combining Gestalt with age-adjusted D-dimer) were called for consent after leaving the ED. Patients were followed for 90 days by medical record review plus telephone, text or email to identify subsequent venous thromboembolism testing. Venous thromboembolism events were independently adjudicated. Feasibility outcomes were recruitment rate, missed eligible rate and follow-up rate. Progression criteria were a recruitment rate of at least five participants per site, per week, a missed eligible rate of no more than two patients per site, per week, and a follow-up rate of at least 90% of enrolled patients.</p><p><strong>Results: </strong>684 patients were tested for PE between 24 March and 10 June 2023. A total of 210 patients were excluded. From 474 eligible patients, 200 were recruited. Median age was 58 years, 72.2% were female, and 3.5% were diagnosed with PE on index visit. Median recruitment rate was 7 participants per site, per week (first-third quartile (Q1-Q3), 4-14) and median missed eligible rate was 6 patients per site, per week (Q1-Q3, 3-8). 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引用次数: 0
摘要
背景:肺栓塞(PE)排除策略的研究传统上是招募急诊科的患者。鉴于急诊科的过度压力,这种方法越来越不切实际。离开急诊科后再联系病人可能更可行。本研究的目的是评估通过电话招募和跟踪患者进行ED PE测试研究的可行性。方法:这是一项前瞻性试点研究,在加拿大安大略省的一个急诊科和一个紧急护理中心进行。成年患者在离开急诊科后,使用adjustment - unlikely(一种结合格式塔和年龄调整d -二聚体的简单决策规则)进行PE测试,征求患者的同意。通过病历回顾、电话、短信或电子邮件对患者进行90天的随访,以确定随后的静脉血栓栓塞试验。静脉血栓栓塞事件独立判定。可行性指标为招募率、漏检率和随访率。进展标准为每周每个研究点至少5名参与者的招募率,每周每个研究点不超过2名患者的错过合格率,以及至少90%入组患者的随访率。结果:684例患者在2023年3月24日至6月10日期间接受了PE检测。共有210名患者被排除在外。从474名符合条件的患者中招募了200名。中位年龄为58岁,72.2%为女性,3.5%在指标就诊时诊断为PE。中位招募率为每个站点每周7名参与者(第一-第三四分位数(Q1-Q3), 4-14),中位未入选率为每个站点每周6名患者(Q1-Q3, 3-8)。90天后,2名受试者退出,191/198 (96.5%,95% CI 92.9, 98.3%)随访。143/198 (72.2%, 95% CI 65.6, 78.0%)参与者不需要肺部成像,因为PE被adjusted - unlikely排除。这些参与者中有1/143 (0.7%,95% CI 0.1, 3.9%)在随访期间被诊断为肺动脉节段性PE。结论:电话招募未达到预先设定的可行性阈值,漏检率高。然而,招募率高于以往的研究,随访损失最小。
Adjust-Unlikely pulmonary embolism testing using telephone recruitment: a pilot study to assess the feasibility of evaluating its safety and efficiency.
Background: Studies on pulmonary embolism (PE) rule-out strategies traditionally recruited patients in the ED. This method is increasingly impractical given excessive pressures experienced in EDs. Attempting to reach patients after leaving the ED may be more feasible. The aim of this study was to assess the feasibility of recruiting and following patients for an ED PE testing study by telephone.
Methods: This was a prospective pilot study conducted in one ED and one urgent care centre in Ontario, Canada. Adult patients tested for PE using Adjust-Unlikely (a simple decision rule combining Gestalt with age-adjusted D-dimer) were called for consent after leaving the ED. Patients were followed for 90 days by medical record review plus telephone, text or email to identify subsequent venous thromboembolism testing. Venous thromboembolism events were independently adjudicated. Feasibility outcomes were recruitment rate, missed eligible rate and follow-up rate. Progression criteria were a recruitment rate of at least five participants per site, per week, a missed eligible rate of no more than two patients per site, per week, and a follow-up rate of at least 90% of enrolled patients.
Results: 684 patients were tested for PE between 24 March and 10 June 2023. A total of 210 patients were excluded. From 474 eligible patients, 200 were recruited. Median age was 58 years, 72.2% were female, and 3.5% were diagnosed with PE on index visit. Median recruitment rate was 7 participants per site, per week (first-third quartile (Q1-Q3), 4-14) and median missed eligible rate was 6 patients per site, per week (Q1-Q3, 3-8). After 90 days, 2 participants withdrew and 191/198 (96.5%, 95% CI 92.9, 98.3%) were contacted in follow-up. 143/198 (72.2%, 95% CI 65.6, 78.0%) participants did not require pulmonary imaging because PE was excluded by Adjust-Unlikely. 1/143 (0.7%, 95% CI 0.1, 3.9%) of these participants was diagnosed with PE in the segmental pulmonary arteries during follow-up.
Conclusions: Telephone recruitment did not meet predefined feasibility thresholds as the missed eligible rate was high. However, the recruitment rate was higher than in previous studies, and there was minimal loss to follow-up.
期刊介绍:
The Emergency Medicine Journal is a leading international journal reporting developments and advances in emergency medicine and acute care. It has relevance to all specialties involved in the management of emergencies in the hospital and prehospital environment. Each issue contains editorials, reviews, original research, evidence based reviews, letters and more.