Welcome to the DiPEP study page

DiPEP: Diagnosis of Pulmonary Embolism in Pregnancy

Pulmonary Embolism (PE) occurs when a blood clot, usually from the veins of the legs, breaks off and travels to the lungs. Pregnant women are at increased risk of PE, and although rare, it is one of the most common causes of death in pregnancy and postpartum that affects women who would otherwise expect to have a long life expectancy in full health.

Patients who have PE that is appropriately diagnosed and treated have a low risk of adverse outcome, so accurate diagnosis can result in substantial benefits. However, it is estimated that only one in every 50 women investigated for suspected PE actually has PE. Furthermore, the investigations used to diagnose PE carry some important risks to the woman, and could also harm the foetus. It is therefore very important that unnecessary treatment is not carried out, while also being sure that a potentially serious PE does not go unnoticed. Clinical decision rules and blood tests are used in non-pregnant people with suspected PE to select those who need investigation, but these have not been properly tested in pregnant women.

We collected information from 181 pregnant or recently pregnant women with PE and 259 women without PE who had been investigated in hospital for a suspected PE. We also collected blood samples from 36 women with PE or deep vein thrombosis (DVT), and 247 with no PE or DVT. We found that none of the clinical decision rules or blood tests were able to reliably determine which women had a PE. Economic analysis showed that scanning every woman with a suspected PE was more cost-effective than any selective approach to scanning.

Key message: Clinical decision rules and blood tests should not be used to determine which women with a suspected PE in pregnancy or postpartum should have a scan.

Publications

The DiPEP study: an observational study of the diagnostic accuracy of clinical assessment, D‐dimer and chest x‐ray for suspected pulmonary embolism in pregnancy and postpartum. BJOG 2018.
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.15286

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium. BJH 2018.
https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.15102

Diagnosis of Pulmonary Embolism in Pregnancy (DiPEP): Case-control study and decision-analysis modelling of diagnostic strategies
https://www.journalslibrary.nihr.ac.uk/programmes/hta/132101/#/

Study Staff:

Name

Role

Organisation

Contact

Prof Steve Goodacre

Chief Investigator

Health Services Research

University of Sheffield

s.goodacre@sheffield.ac.uk

+44 (0) 114 222 0842

Prof Cindy Cooper

CTRU Director

Clinical Trials Research Unit (CTRU)

University of Sheffield

c.l.cooper@sheffield.ac.uk

+44 (0) 114 222 0743

Kimberley Horspool

Study Manager

Health Services Research

University of Sheffield

k.horspool@sheffield.ac.uk

+44 (0) 114 222 4348

Diana Papaioannou

CTRU Adviser

Clinical Trials Research Unit (CTRU)

University of Sheffield

d.papaioannou@sheffield.ac.uk

+44 (0) 114 222 0766

Ellen Bradley

Research Assistant

Clinical Trials Research Unit (CTRU)

University of Sheffield

e.bradley@sheffield.ac.uk

+44 (0) 114 222 0843

Heather Dakin

Trial Support Officer

Clinical Trials Research Unit (CTRU)

University of Sheffield

h.dakin@sheffield.ac.uk

+44 (0) 114 222 6385

Dr Amanda Loban

Data Manager

Clinical Trials Research Unit (CTRU)

University of Sheffield

a.loban@sheffield.ac.uk

+44 (0) 114 222 2995

Prof Michael Campbell

Senior Statistician

Medical Statistics Group

University of Sheffield

m.j.campbell@sheffield.ac.uk

Neil Shephard

Statistician

Clinical Trials Research Unit (CTRU)

University of Sheffield

n.shephard@sheffield.ac.uk

+44 (0) 114 222 5203

Prof Matt Stevenson

Health Economics / Decision Modelling

Health Economics and Decision Science

University of Sheffield

m.d.stevenson@sheffield.ac.uk

+44 (0) 114 222 0691

Prof Marian Knight

Co-Applicant (UKOSS Lead)

University of Oxford

marian.knight@npeu.ox.ac.uk

Prof Beverley Hunt

Co-Applicant (Biomarker study lead)

Guy’s and St. Thomas’

NHS Foundation Trust

Beverley.Hunt@gstt.nhs.uk

+44 (0) 207 188 2736

Prof Catherine Nelson-Piercy

Clinical Investigator (Obstetrics)

Guy’s and St. Thomas’

NHS Foundation Trust

catherine.nelson-piercy@gstt.nhs.uk

+44 (0) 207 188 7905

Prof Fiona Lecky

Clinical Investigator (Emergency Medicine)

Health Services Research

University of Sheffield

f.e.lecky@sheffield.ac.uk

+44 (0) 114 222 4345

Dr Steven Thomas

Clinical Investigator (Radiology)

Sheffield Teaching Hospitals

NHS Foundation Trust

s.m.thomas@sheffield.ac.uk

+44 (0) 114 222 2993

Dr Erica Wallis

Sponsor

Sheffield Teaching Hospitals

NHS Foundation Trust

Erica.Wallis@sth.nhs.uk

+44 (0) 114 226 5976

This project is funded by the National Institute for Health Research Health Technology Assessment Programme (13/21/01)
The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Technology Assessment Programme, NIHR, NHS or the Department of Health.