Cite this post as:
Scott Weingart, MD FCCM. Do Patients with COPD Exac need a PE Workup?. EMCrit Blog. Published on May 28, 2015. Accessed on May 8th 2024. Available at [https://emcrit.org/emcrit/do-patients-with-copd-exac-need-a-pe-workup/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: May 28, 2015
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Hey Scott Are your trying to pick a Twitter fight! PE seems to inflame the masses! N = 49 – so not really enough data to make conclusions about much. Definitely too small to be a “game changer” for such an important question. The presence of a PE or ‘pee wee E’ on a 64slice CT is not a meaningful clinical outcome. Much of those could well be “lung lint” – i.e. clot that the lung has successfully filtered out of old folks blood! A better outcome would be death by PE (need 1000s of pts for that) or at… Read more »
pretty scary conclusion, knee jerk work up for every COPD exacerbation, I wonder if a preceding URI,change in sputum color or volume,etc would explain the etiology for the flare and thus this subgroup would be less likely to have a coexistent PE as a cause..let’s hope for a larger study in the future
Agree that the real question is whether finding the PE alters outcome in this group ( or any group for that matter….:-)
For that we need to better understand the untreated mortality and morbidity in this group ( and predictors thereof), AND have faith that anticoagulation is more benefit than harm
My first thought was “n=49”? This changes no game (unless the other team has n=48?). What we really need to know is what characteristics of a COPD exacerbation, or pleural effusion, or asthma exacerbation… should cause us to do a PE workup. Always love the PE discussion, “How should we work up PE?” We don’t workup PE, we workup chest pain, shortness of breath. Not PE. The PE workup is stupidly simple, get a CTA or VQ. The questions that are important are: 1. When do we pull the trigger to get those tests? 2. What do we do with… Read more »
great way to put it thanks
Agree with the above – not a game changer at all. In fact, it would be dangerous to change practice based on this tiny study. Given the clinicians diagnosed infective exacerbations of COPD, there is a real chance that many of these PE’s are incidental PE’s of questionable relevance. Given how little we know about the value of discovering incidental PE and any benefit of treating such PE’s v’s the harms of testing and anticoagulation, it would be very dangerous to advocate anything that resembles a “PE screening program” in certain populations. This is particularly of concern given there is… Read more »
This study has a few serious issues with presentation that make its significance and generalizability hard to determine. First, it is missing the consort diagram, which is essential in a study of this nature. They give the impression (in fact, that state point blank) that it was a study of 49 consecutive patients with AECOPD. The reality is that is unlikely to be true. Any clinical trialist knows that enrollment is clinical trials is difficult, especially in an ED or ICU setting where things happen quickly. More likely is that 49 consecutive patients with UNEXPLAINED AECOPD were included. The distinction… Read more »
very nice comment