{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T15:18:12Z","timestamp":1789226292315,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T00:00:00Z","timestamp":1658275200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS025979"],"award-info":[{"award-number":["R01HS025979"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We sought to determine associations of early electrocardiogram (ECG) patterns with clinical deterioration (CD) within 5\u2009days and with RV abnormality (abnlRV) by echocardiography in pulmonary embolism (PE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this prospective, multicenter study of newly confirmed PE patients, early echocardiography and initial ECG were examined. Initial ECG patterns included lead\u2010specific ST\u2010segment elevation (STE) or depression (STD), T\u2010wave inversion (TWI), supraventricular tachycardia (SVT), sinus tachycardia, and right bundle branch block as complete (cRBBB) or incomplete (iRBBB). We defined CD as respiratory failure, hypotension, dysrhythmia, cardiac arrest, escalated PE intervention, or death within 5\u2009days. We calculated odds ratios (ORs) for CD and abnlRV with univariate and full multivariate models in the presence of other variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1676 patients, 1629 (97.2%) had both ECG and GDE; 415\/1676 (24.7%) had CD, and 529\/1629 (32.4%) had abnlRV. AbnlRV had an OR for CD of 4.25 (3.35, 5.38). By univariable analysis, the absence of abnormal ECG patterns had OR for CD and abnlRV of 0.34 (0.26, 0.44; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and 0.24 (0.18, 0.31; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), respectively. By multivariable analyses, one ECG pattern had a significant OR for CD: SVT 2.87 (1.66, 5.00). Significant ORS for abnlRV were: TWI V<jats:sub>2\u20134<\/jats:sub> 4.0 (2.64, 6.12), iRBBB 2.63 (1.59, 4.38), STE aVR 2.42 (1.58, 3.74), S1\u2010Q3\u2010T3 2.42 (1.70, 3.47), and sinus tachycardia 1.68 (1.14, 2.49).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SVT was an independent predictor of CD. TWI V<jats:sub>2\u20134<\/jats:sub>, iRBBB, STE aVR, sinus tachycardia, and S1\u2010Q3\u2010T3 were independent predictors of abnlRV. Finding one or more of these ECG patterns may increase considerations for performance of echocardiography to look for RV abnormalities and, if present, inform concerns for early clinical deterioration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14554","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T09:49:21Z","timestamp":1656064161000},"page":"1185-1196","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9309-7910","authenticated-orcid":false,"given":"Anthony J.","family":"Weekes","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Atrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short\u2010term Outcomes Registry (PESCOR) consortium)  Charlotte North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaron D.","family":"Raper","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Atrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short\u2010term Outcomes Registry (PESCOR) consortium)  Charlotte North Carolina USA"},{"name":"Jaron D. Raper, Department of Emergency Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa M.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Atrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short\u2010term Outcomes Registry (PESCOR) consortium)  Charlotte North Carolina USA"},{"name":"Alyssa M. Thomas, Emergency Department Houston Methodist Baytown Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Lupez","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Atrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short\u2010term Outcomes Registry (PESCOR) consortium)  Charlotte North Carolina USA"},{"name":"Kathryn Lupez, Department of Emergency Medicine Tufts Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly A.","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Atrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short\u2010term Outcomes Registry (PESCOR) consortium)  Charlotte North Carolina USA"},{"name":"Carly A. Cox, Emergency Medicine of Idaho  Meridian Idaho USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dasia","family":"Esener","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Kaiser Permanente  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy S.","family":"Boyd","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason T.","family":"Nomura","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Christiana Care  Newark Delaware USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian","family":"Davison","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Orlando Health  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick M.","family":"Ockerse","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine University of Utah Health  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Leech","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Orlando Health  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Abrams","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Kaiser Permanente  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Kelly","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine University of Utah Health  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel S.","family":"O'Connell","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/anec.12278"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12769"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.08.030"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.120.2.474"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-011-0395-z"},{"issue":"7","key":"e_1_2_9_7_1","first-page":"744","article-title":"Is it possible to use standard electrocardiography for risk assessment of patients with pulmonary embolism?","volume":"67","author":"Kostrubiec M","year":"2009","journal-title":"Kardiol Pol"},{"issue":"7","key":"e_1_2_9_8_1","first-page":"649","article-title":"The prognostic value of ST\u2010segment elevation 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