Pulmonary embolism prevalence among emergency department cohorts: A systematic review and meta‐analysis by country of study

Abstract

Unlabelled Box AbstractBackgroundThere is an impression that North American emergency department (ED) patients tested for pulmonary embolism (PE) differ from European ones. ObjectivesWe compared the PE prevalence, frequency of use, and positive yield of imaging among ED patients tested for PE in Europe and North America. MethodsWe searched for studies reporting consecutive ED patients tested for PE. Two authors screened full texts, performed risk of bias assessment, and data extraction. We conducted a meta‐analysis of proportions for each outcome and a multiple meta‐regression. ResultsFrom 3109 publications, 44 were included in the systematic review. The prevalence of PE in Europe was 23% (95% confidence interval [CI], 21‐26) and in North America 8% (95% CI, 6‐9). The adjusted mean difference (aMD) in the prevalence of PE in the European compared with North American studies, was 15% (95% CI, 10‐20). Computed tomography pulmonary angiography (CTPA) was used in 60% (95% CI, 52%‐68) of European and 38% (95% CI, 24‐51) of North American patients tested for PE (aMD, 23% [95% CI, 7‐39]). The CTPA diagnostic yield was 29% (95% CI, 26‐32) in Europe and 13% (95% CI, 9‐17) in North America (aMD, 15% [95% CI, 8‐21]). ConclusionCompared with North America, European ED studies have a higher prevalence of PE and diagnostic yield from CTPA, despite a higher frequency of CTPA use among patients tested for PE. This supports the hypothesis that those tested for PE in North American EDs have a lower risk of PE compared with Europe.