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Acute Pulmonary Embolism in an Intensive Care Unit Setting in Sierra Leone
J B W Russell1,2, S Baio1, T R Koroma1
1Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone.
West African Journal of Medicine
|October 19, 2022
Summary
In Sierra Leone, pulmonary embolism (PE) diagnosis lacked standardized scoring, with physicians rarely using pre-test probability scores before CTPA. This highlights a gap in evidence-based PE management and diagnosis in the region.
Area of Science:
- Pulmonary Medicine
- Diagnostic Imaging
- Clinical Epidemiology
Background:
- Pulmonary embolism (PE) diagnosis and management in Sierra Leone lack standardized, evidence-based protocols.
- Limited data exists on the clinical characteristics and diagnostic work-up of PE in this setting.
Purpose of the Study:
- To describe the clinical profile and management of acute PE in Sierra Leone.
- To assess the utilization of pre-test probability scoring algorithms before CTPA for PE diagnosis.
Main Methods:
- Retrospective observational study of CTPA-confirmed PE patients in Freetown, Sierra Leone (July 2014-June 2019).
- Clinical data, investigations, and CTPA findings were analyzed.
- Pre-test clinical probability scores (PCPS) were calculated and compared with CTPA results.
Main Results:
- 79 CTPA-confirmed PE cases (1.9% of admissions) were identified, with a mean age of 64.1 years.
- Dyspnea and tachycardia were common symptoms; immobilization was the main risk factor.
- Pre-test probability scoring (Wells, Geneva) was significantly underutilized (9.5% for Wells, 0% for Geneva).
- Hemodynamically stable PE was more frequent (69.6%).
- In-hospital mortality was 17.7%.
Conclusions:
- Pre-test probability scoring for PE diagnosis is infrequently used in clinical practice in Sierra Leone.
- Physician reliance on empirical judgment for CTPA requests may contribute to the low PE diagnosis rate.
- Establishing a PE registry in Sierra Leone is crucial for improving diagnosis and management.
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