1
|
Elias A, Schmidt J, Bellou A, Le Gal G, Roy PM, Mismetti P, Meyer G, Clarke M. Opinion and practice survey about the use of prognostic models in acute pulmonary embolism. Thromb Res 2020; 198:40-48. [PMID: 33278785 DOI: 10.1016/j.thromres.2020.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Methods for prognosis assessment and patient management in acute pulmonary embolism (PE) are much debated among physicians. We conducted an online survey to determine physician's attitudes and barriers towards the use of prognostic models when treating patients with acute PE. METHOD Physicians members of the French and the European scientific societies for emergency medicine or of a French thrombosis research network were reached by their respective scientific societies and invited to participate via email. The questionnaire was a mixture of close-ended with yes-no or multiple-choice options and a small number of open-ended questions. RESULTS The survey included 461 respondents. The most commonly used prognostic tools were clinical judgment (36%) and prognostic models (29.5%). Prognostic models were used by 57% of respondents in more than half of all cases and prognostic indicators by 62% in addition to prognostic models. Affiliation group and type of hospital emerged as independent predictors for choosing prognostic models. Many (52%) reported lack of familiarity with the models and reported clinical judgment (60%) or hospital checklists (73%) as being as good as or better than prognostic models. The highest acceptable 30-day mortality rate limit for early discharge or outpatient management was deemed to be 1%, but few patients are discharged early or completely managed on an outpatient basis. CONCLUSIONS This survey provides new information for implementing knowledge translation strategies to improve prognostic risk assessment for acute PE patients, and highlights the need for considering the use of clinical judgment and hospital checklists in future clinical research.
Collapse
Affiliation(s)
- Antoine Elias
- Department for Continuing Education Professional Development, University of Oxford, Oxford, United Kingdom; Service de Médecine Vasculaire, Pôle Cardiologie-Vasculaire, Hôpital Sainte Musse, Centre Hospitalier Intercommunal Toulon La Seyne-sur-Mer, Toulon, France; INNOVTE (INvestigation Network On Venous ThromboEmbolism) F-CRIN (French Clinical Research Infrastructure) Network, France.
| | - Jeannot Schmidt
- INNOVTE (INvestigation Network On Venous ThromboEmbolism) F-CRIN (French Clinical Research Infrastructure) Network, France; Pôle Urgences, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France; Université 1 d'Auvergne, Clermont Ferrand, France; French Society for Emergency Medicine (SFMU), France
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA; European Society for Emergency Medicine (EuSEM), Brussels, Belgium
| | - Grégoire Le Gal
- INNOVTE (INvestigation Network On Venous ThromboEmbolism) F-CRIN (French Clinical Research Infrastructure) Network, France; Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; Université de Brest, Brest, France
| | - Pierre-Marie Roy
- INNOVTE (INvestigation Network On Venous ThromboEmbolism) F-CRIN (French Clinical Research Infrastructure) Network, France; French Society for Emergency Medicine (SFMU), France; Département de Médecine d'Urgence, Centre Vasculaire et de la Coagulation, Centre Hospitalier Universitaire d'Angers, France; UMR (CNRS 6015 - INSERM 1083) et Institut MitoVasc, Université d'Angers, France
| | - Patrick Mismetti
- INNOVTE (INvestigation Network On Venous ThromboEmbolism) F-CRIN (French Clinical Research Infrastructure) Network, France; Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalier Universitaire de Saint-Etienne, France; Université Jean Monnet, Groupe d'Investigation et de Recherche Clinique sur la Thrombose, Saint-Etienne, France; Unité de Pharmacologie Clinique, Centre Hospitalier Universitaire de Saint-Etienne, France
| | - Guy Meyer
- INNOVTE (INvestigation Network On Venous ThromboEmbolism) F-CRIN (French Clinical Research Infrastructure) Network, France; Service de Pneumologie, Hôpital Européen Georges Pompidou, France; Université Paris Descartes, Sorbonne, Paris Cité, France
| | - Mike Clarke
- Department for Continuing Education Professional Development, University of Oxford, Oxford, United Kingdom; Northern Ireland Network for Trials Methodology Research, Queen's University Belfast, Belfast, United Kingdom
| |
Collapse
|
2
|
Faller N, Stalder O, Limacher A, Bassetti S, Beer JH, Genné D, Battegay E, Hayoz D, Leuppi J, Mueller B, Perrier A, Waeber G, Rodondi N, Aujesky D. Frequency of use and acceptability of clinical prediction rules for pulmonary embolism among Swiss general internal medicine residents. Thromb Res 2017; 160:9-13. [PMID: 29080550 DOI: 10.1016/j.thromres.2017.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Whether clinical prediction rules for pulmonary embolism are accepted and used among general internal medicine residents remains uncertain. We therefore evaluated the frequency of use and acceptability of the Revised Geneva Score (RGS) and the Pulmonary Embolism Severity Index (PESI), and explored which factors were associated with rule use. MATERIALS/METHODS In an online survey among general internal medicine residents from 10 Swiss hospitals, we assessed rule acceptability using the Ottawa Acceptability of Decision Rules Instrument (OADRI) and explored the association between physician and training-related factors and rule use using mixed logistic regression models. RESULTS The response rate was 50.4% (433/859). Overall, 61% and 36% of the residents reported that they always or regularly use the RGS and the PESI, respectively. The mean overall OADRI score was 4.3 (scale 0-6) for the RGS and 4.1 for the PESI, indicating a good acceptability. Rule acceptability (odds ratio [OR] 6.19 per point, 95% confidence interval [CI] 3.64-10.51), prior training in emergency medicine (OR 5.14, CI 2.20-12.01), and availability of internal guidelines recommending RGS use (OR 4.25, CI 2.15-8.43) were associated with RGS use. Rule acceptability (OR 6.43 per point, CI 4.17-9.92) and rule taught at medical school (OR 2.06, CI 1.24-3.43) were associated with PESI use. CONCLUSIONS The RGS was more frequently used than the PESI. Both rules were considered acceptable. Rule acceptability, prior training in emergency medicine, availability of internal guidelines, and rule taught at medical school were associated with rule use and represent potential targets for quality improvement interventions.
Collapse
Affiliation(s)
- N Faller
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - O Stalder
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - A Limacher
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - S Bassetti
- Division of Internal Medicine, Basel University hospital, Basel, Switzerland
| | - J H Beer
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - D Genné
- Department of Internal Medicine, Cantonal Hospital of Biel, Biel, Switzerland
| | - E Battegay
- Department of Internal Medicine, Zürich University Hospital, Zürich, Switzerland
| | - D Hayoz
- Department of Internal Medicine, Cantonal Hospital of Fribourg, Fribourg, Switzerland
| | - J Leuppi
- University Clinic of Internal Medicine, Cantonal Hospital Baselland, Liestal, and University of Basel, Switzerland
| | - B Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - A Perrier
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - G Waeber
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - N Rodondi
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - D Aujesky
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|