Are small PEs more benign? Probably but this doesn’t help.

Cha S-I, Shin K-M, Lee J-W, Lee J, Lee S-Y, Kim C-H, et al. Clinical characteristics of patients with peripheral pulmonary embolism. Respiration. 2010;80(6):500–508. PMID 20110642

Someone alerted me to this paper and I’m not sure who. If it was you let me know and I can at least give you credit!

Of course, this is a really important question – do the small PEs do OK without anticoagulation? I’m not sure this helps much.

METHODS

• unfortunately terrible
• EMR chart review
• pts included were those who had CTPA with the legs included
• so we can’t be sure about the clinical features of actual PE pts cause we don’t know if they are all in the study
• classifed radiologically after the fact as big or small
• did things like try and calculate a Well’s score retrospectively (how can you decide if P an alternate diagnosis is likely from a chart? – with difficulty…)

RESULTS

• 250 pts: most big, very few sub-segmental so that limits the results of the group that we’re actually interested in
• 60% of the smaller PEs were defined as incidental (though I don’t really know what his means. Were the scans for some other acute pathology or routine follow up for cancer etc…?)
• the big ones got treated, the smaller ones often didn’t. Again, I don’t know what this means

THOUGHTS

• they suggest that sub-segmentals have a more benign outcome and that’s likely true, but this is no proof of it.