Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts

Paul L. den Exter; Lucia J.M. Kroft; Carol Gonsalves; Gregoire Le Gal; Cornelia M. Schaefer-Prokop; Marc Carrier; Menno V. Huisman; Frederikus A. Klok; L. Meijboom; L. F. Beenen; A. de Roos; I. J.C. Hartmann; C. Dennie; M. P. Revel; L. Haramati; E. van Beek; N. Screaton; G. Ferretti; B. Ghaye; M. Das; C. White; E. Pena Fernandez; N. Paul; I. Vlahos; R. D. Renapurkar; J. Ravenel; J. Kanne; S. Abbara; M. Rémy-Jardin; B. Geurts; T. Frauenfelder; N. Sverzellati; H. Prosch; J. M. Goo; J. Vogel-Claussen; P. J. MacMahon; S. Bhalla; S. Kahn; S. Shivakumar; P. Wells; M. Rodger; L. Castellucci; L. Duffett; A. Delluc; D. Siegal; A. Lazo-Langner; C. Wu; A. Lee; D. Garcia; J. Zwicker; D. Aujesky; D. Jimenez; M. Righini; M. Blondon; C. Ay; S. Barco; P. W. Kamphuisen; M. Ferreira; O. Sanchez; L. K. Moores; C. Tromeur; W. Ageno; B. Hunt; P. Prandoni; M. Monreal; M. Crowther; P. M. Roy; I. Pabinger; M. P. Donadini; F. Moustafa; L. Jara-Palomares; R. Pedroc; L. Bertoletti; P. Verhamme; H. C.J. Eikenboom; F. J.M. van der Meer; H. R. Büller; N. van Es

doi:10.1002/rth2.12422

Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts

Paul L. den Exter, Lucia J.M. Kroft, Carol Gonsalves, Gregoire Le Gal, Cornelia M. Schaefer-Prokop, Marc Carrier, Menno V. Huisman, Frederikus A. Klok, L. Meijboom, L. F. Beenen, A. de Roos, I. J.C. Hartmann, C. Dennie, M. P. Revel, L. Haramati, E. van Beek, N. Screaton, G. Ferretti, B. Ghaye, M. DasC. White, E. Pena Fernandez, N. Paul, I. Vlahos, R. D. Renapurkar, J. Ravenel, J. Kanne, S. Abbara, M. Rémy-Jardin, B. Geurts, T. Frauenfelder, N. Sverzellati, H. Prosch, J. M. Goo, J. Vogel-Claussen, P. J. MacMahon, S. Bhalla, S. Kahn, S. Shivakumar, P. Wells, M. Rodger, L. Castellucci, L. Duffett, A. Delluc, D. Siegal, A. Lazo-Langner, C. Wu, A. Lee, D. Garcia, J. Zwicker, D. Aujesky, D. Jimenez, M. Righini, M. Blondon, C. Ay, S. Barco, P. W. Kamphuisen, M. Ferreira, O. Sanchez, L. K. Moores, C. Tromeur, W. Ageno, B. Hunt, P. Prandoni, M. Monreal, M. Crowther, P. M. Roy, I. Pabinger, M. P. Donadini, F. Moustafa, L. Jara-Palomares, R. Pedroc, L. Bertoletti, P. Verhamme, H. C.J. Eikenboom, F. J.M. van der Meer, H. R. Büller, N. van Es

Medicine

Producción científica: Contribución a una revista › Artículo › revisión exhaustiva

24 Citas (Scopus)

Resumen

Background: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. Objectives: We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. Methods: Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. Results: Twenty-nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of ≤1 mm. These criteria were approved by 83% of the clinical venous thromboembolism (VTE) specialists. The clinical expert panel favored anticoagulant treatment in case of prior VTE, antiphospholipid syndrome, pregnancy, cancer, and proximal deep vein thrombosis. Conclusion: The results of this analysis provide standard radiological criteria for ssPE that may be applicable in both clinical trials and practice.

Idioma original	English
Páginas (desde-hasta)	1251-1261
Número de páginas	11
Publicación	Research and Practice in Thrombosis and Haemostasis
Volumen	4
N.º	8
DOI	https://doi.org/10.1002/rth2.12422
Estado	Published - nov. 2020

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Publisher Copyright:
© 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.

ASJC Scopus Subject Areas

Hematology

PubMed: MeSH publication types

Journal Article

ODS de las Naciones Unidas

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den Exter, P. L., Kroft, L. J. M., Gonsalves, C., Le Gal, G., Schaefer-Prokop, C. M., Carrier, M., Huisman, M. V., Klok, F. A., Meijboom, L., Beenen, L. F., de Roos, A., Hartmann, I. J. C., Dennie, C., Revel, M. P., Haramati, L., van Beek, E., Screaton, N., Ferretti, G., Ghaye, B., ... van Es, N. (2020). Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts. Research and Practice in Thrombosis and Haemostasis, 4(8), 1251-1261. https://doi.org/10.1002/rth2.12422

den Exter, PL, Kroft, LJM, Gonsalves, C, Le Gal, G, Schaefer-Prokop, CM, Carrier, M, Huisman, MV, Klok, FA, Meijboom, L, Beenen, LF, de Roos, A, Hartmann, IJC, Dennie, C, Revel, MP, Haramati, L, van Beek, E, Screaton, N, Ferretti, G, Ghaye, B, Das, M, White, C, Pena Fernandez, E, Paul, N, Vlahos, I, Renapurkar, RD, Ravenel, J, Kanne, J, Abbara, S, Rémy-Jardin, M, Geurts, B, Frauenfelder, T, Sverzellati, N, Prosch, H, Goo, JM, Vogel-Claussen, J, MacMahon, PJ, Bhalla, S, Kahn, S, Shivakumar, S, Wells, P, Rodger, M, Castellucci, L, Duffett, L, Delluc, A, Siegal, D, Lazo-Langner, A, Wu, C, Lee, A, Garcia, D, Zwicker, J, Aujesky, D, Jimenez, D, Righini, M, Blondon, M, Ay, C, Barco, S, Kamphuisen, PW, Ferreira, M, Sanchez, O, Moores, LK, Tromeur, C, Ageno, W, Hunt, B, Prandoni, P, Monreal, M, Crowther, M, Roy, PM, Pabinger, I, Donadini, MP, Moustafa, F, Jara-Palomares, L, Pedroc, R, Bertoletti, L, Verhamme, P, Eikenboom, HCJ, van der Meer, FJM, Büller, HR & van Es, N 2020, 'Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts', Research and Practice in Thrombosis and Haemostasis, vol. 4, n.º 8, pp. 1251-1261. https://doi.org/10.1002/rth2.12422

@article{675c76364a6b46429da1ceb6c91f4dc0,

title = "Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts",

abstract = "Background: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. Objectives: We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. Methods: Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. Results: Twenty-nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of ≤1 mm. These criteria were approved by 83% of the clinical venous thromboembolism (VTE) specialists. The clinical expert panel favored anticoagulant treatment in case of prior VTE, antiphospholipid syndrome, pregnancy, cancer, and proximal deep vein thrombosis. Conclusion: The results of this analysis provide standard radiological criteria for ssPE that may be applicable in both clinical trials and practice.",

author = "{den Exter}, {Paul L.} and Kroft, {Lucia J.M.} and Carol Gonsalves and {Le Gal}, Gregoire and Schaefer-Prokop, {Cornelia M.} and Marc Carrier and Huisman, {Menno V.} and Klok, {Frederikus A.} and L. Meijboom and Beenen, {L. F.} and {de Roos}, A. and Hartmann, {I. J.C.} and C. Dennie and Revel, {M. P.} and L. Haramati and {van Beek}, E. and N. Screaton and G. Ferretti and B. Ghaye and M. Das and C. White and {Pena Fernandez}, E. and N. Paul and I. Vlahos and Renapurkar, {R. D.} and J. Ravenel and J. Kanne and S. Abbara and M. R{\'e}my-Jardin and B. Geurts and T. Frauenfelder and N. Sverzellati and H. Prosch and Goo, {J. M.} and J. Vogel-Claussen and MacMahon, {P. J.} and S. Bhalla and S. Kahn and S. Shivakumar and P. Wells and M. Rodger and L. Castellucci and L. Duffett and A. Delluc and D. Siegal and A. Lazo-Langner and C. Wu and A. Lee and D. Garcia and J. Zwicker and D. Aujesky and D. Jimenez and M. Righini and M. Blondon and C. Ay and S. Barco and Kamphuisen, {P. W.} and M. Ferreira and O. Sanchez and Moores, {L. K.} and C. Tromeur and W. Ageno and B. Hunt and P. Prandoni and M. Monreal and M. Crowther and Roy, {P. M.} and I. Pabinger and Donadini, {M. P.} and F. Moustafa and L. Jara-Palomares and R. Pedroc and L. Bertoletti and P. Verhamme and Eikenboom, {H. C.J.} and {van der Meer}, {F. J.M.} and B{\"u}ller, {H. R.} and {van Es}, N.",

note = "Publisher Copyright: {\textcopyright} 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.",

year = "2020",

month = nov,

doi = "10.1002/rth2.12422",

language = "English",

volume = "4",

pages = "1251--1261",

journal = "Research and Practice in Thrombosis and Haemostasis",

issn = "2475-0379",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "8",

}

TY - JOUR

T1 - Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism

T2 - A Delphi analysis of experts

AU - den Exter, Paul L.

AU - Kroft, Lucia J.M.

AU - Gonsalves, Carol

AU - Le Gal, Gregoire

AU - Schaefer-Prokop, Cornelia M.

AU - Carrier, Marc

AU - Huisman, Menno V.

AU - Klok, Frederikus A.

AU - Meijboom, L.

AU - Beenen, L. F.

AU - de Roos, A.

AU - Hartmann, I. J.C.

AU - Dennie, C.

AU - Revel, M. P.

AU - Haramati, L.

AU - van Beek, E.

AU - Screaton, N.

AU - Ferretti, G.

AU - Ghaye, B.

AU - Das, M.

AU - White, C.

AU - Pena Fernandez, E.

AU - Paul, N.

AU - Vlahos, I.

AU - Renapurkar, R. D.

AU - Ravenel, J.

AU - Kanne, J.

AU - Abbara, S.

AU - Rémy-Jardin, M.

AU - Geurts, B.

AU - Frauenfelder, T.

AU - Sverzellati, N.

AU - Prosch, H.

AU - Goo, J. M.

AU - Vogel-Claussen, J.

AU - MacMahon, P. J.

AU - Bhalla, S.

AU - Kahn, S.

AU - Shivakumar, S.

AU - Wells, P.

AU - Rodger, M.

AU - Castellucci, L.

AU - Duffett, L.

AU - Delluc, A.

AU - Siegal, D.

AU - Lazo-Langner, A.

AU - Wu, C.

AU - Lee, A.

AU - Garcia, D.

AU - Zwicker, J.

AU - Aujesky, D.

AU - Jimenez, D.

AU - Righini, M.

AU - Blondon, M.

AU - Ay, C.

AU - Barco, S.

AU - Kamphuisen, P. W.

AU - Ferreira, M.

AU - Sanchez, O.

AU - Moores, L. K.

AU - Tromeur, C.

AU - Ageno, W.

AU - Hunt, B.

AU - Prandoni, P.

AU - Monreal, M.

AU - Crowther, M.

AU - Roy, P. M.

AU - Pabinger, I.

AU - Donadini, M. P.

AU - Moustafa, F.

AU - Jara-Palomares, L.

AU - Pedroc, R.

AU - Bertoletti, L.

AU - Verhamme, P.

AU - Eikenboom, H. C.J.

AU - van der Meer, F. J.M.

AU - Büller, H. R.

AU - van Es, N.

PY - 2020/11

Y1 - 2020/11

N2 - Background: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. Objectives: We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. Methods: Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. Results: Twenty-nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of ≤1 mm. These criteria were approved by 83% of the clinical venous thromboembolism (VTE) specialists. The clinical expert panel favored anticoagulant treatment in case of prior VTE, antiphospholipid syndrome, pregnancy, cancer, and proximal deep vein thrombosis. Conclusion: The results of this analysis provide standard radiological criteria for ssPE that may be applicable in both clinical trials and practice.

AB - Background: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. Objectives: We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. Methods: Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. Results: Twenty-nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of ≤1 mm. These criteria were approved by 83% of the clinical venous thromboembolism (VTE) specialists. The clinical expert panel favored anticoagulant treatment in case of prior VTE, antiphospholipid syndrome, pregnancy, cancer, and proximal deep vein thrombosis. Conclusion: The results of this analysis provide standard radiological criteria for ssPE that may be applicable in both clinical trials and practice.

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UR - http://www.scopus.com/inward/citedby.url?scp=85096206176&partnerID=8YFLogxK

U2 - 10.1002/rth2.12422

DO - 10.1002/rth2.12422

M3 - Article

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AN - SCOPUS:85096206176

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VL - 4

SP - 1251

EP - 1261

JO - Research and Practice in Thrombosis and Haemostasis

JF - Research and Practice in Thrombosis and Haemostasis

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Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts

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Nota bibliográfica

ASJC Scopus Subject Areas

PubMed: MeSH publication types

ODS de las Naciones Unidas

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