Search

Objective: Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. Several diagnostic prediction rules based on pretest probability and D-dimer have been validated in non-COVID patients, but it remains unclear if they can be safely applied in COVID-19 patients. We aimed to compare the diagnostic accuracy of the standard approach based on Wells and Geneva scores combined with a standard D-dimer cut-off of 500 ng/mL with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in COVID-19 patients., Methods: This retrospective study included all COVID-19 patients admitted to the Emergency Department (ED) who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. The diagnostic prediction rules for PE were compared between patients with and without PE., Results: We included 300 patients and PE was confirmed in 15%. No differences were found regarding comorbidities, traditional risk factors for PE and signs and symptoms between patients with and without PE. Wells and Geneva scores showed no predictive value for PE occurrence, whether a standard or an age-adjusted cut-off was considered. YEARS and PEGeD algorithms were associated with increased specificity (19% CTPA reduction) but raising non-diagnosed PE. Despite elevated in all patients, those with PE had higher D-dimer levels. However, incrementing thresholds to select patients for CTPA was also associated with a substantial decrease in sensitivity., Conclusion: None of the diagnostic prediction rules are reliable predictors of PE in COVID-19. Our data favour the use of a D-dimer threshold of 500 ng/mL, considering that higher thresholds increase specificity but limits this strategy as a screening test., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: The predictors of patient satisfaction in emergency medicine (EM) have been widely studied and discussed in the scientific literature; the results vary depending on the specific EM attributes, cultural aspects, researchers' preferences, and approaches. However, it is not clear whether the same predictors of patient satisfaction can contribute to a better-perceived quality of healthcare or whether patients' perceptions form a different attitude toward satisfaction and perceived quality of healthcare. The goal of this study was to identify the key predictors of patient satisfaction and perceived quality of healthcare in the framework of an emergency department (ED)., Methods: We conducted a retrospective study of patients seen at an ED between January -December 2016. Data collection took place in the public hospital in Lisbon, Portugal, between May - November 2017. The total sample size included 382 patients. The sample distribution had a 5% margin of error and a 95% confidence interval. Data for this research, using a questionnaire, was collected by mail or e-mail according to the respondent's preference., Results: A detailed analysis showed that three out of the 18 predictors had a statistically significant relationship with satisfaction: overall satisfaction with doctors, with a positive correlation (r = 0.14, p ≤ 0.01); qualitative perceived waiting time for triage, with a positive correlation (r = 0.08, p ≤ 0.05); and meeting expectations, with a positive correlation (r = 0.53, p ≤ 0.01). Furthermore, a detailed analysis showed that only two out of the 18 predictors had a statistically significant relationship with the perceived quality of healthcare (PQHC): overall satisfaction with doctors, with a positive correlation (r = 0.43, p ≤ 0.01) and meeting expectations, with a positive correlation (r = 0.26, p ≤ 0.01)., Conclusion: The main predictors of satisfaction and perceived quality of healthcare were overall satisfaction with doctors and meeting expectations. We should note that "meeting expectations" plays the most important role in terms of satisfaction; however, in terms of PQHC the predictor "overall satisfaction with doctors" plays the most important role due to its stronger correlation. In addition, the qualitative perceived waiting time for triage could be considered as another predictor, influencing satisfaction only, thus emphasizing similarities and differences between satisfaction and the PQHC in an ED context.