Inaccurate Diagnosis Of Pulmonary Embolism

Abstract

The likelihood and implications of making a false positive or false negative diagnosis of pulmonary embolism (PE) were studied at a large private hospital in 1980. Predictive accuracy (PreAc) of various lung scan patterns have been determined by McNeil and Biello using patients undergoing both lung scanning and pulmonary angiography. Using their criteria, 162 consecutive patients undergoing initial perfusion lung scan (ordered by 81 physicians) were studied. Cases were categorized by PreAc of the lung scan.Conclusion: So far this study, where 250 patients are to be included, has not revealed any difference in follow-up venous function between legs with and without postoperative thrombosis as diagnosed with FUT.In all groups many therapeutic decisions were made based on only medium probability for PE, increasing the possibilities of false positive and false negative diagnoses. It is therefore suggested that physicians be better educated about utilizing principles of probability and decision theory in order to help them maximize PreAc in PE. In patients with medium probability (10-90%) for PE the risks of an invasive procedure are low compared to the risks resulting from a false negative or false positive diagnosis. Therefore, more frequent use of venograms and angiograms would be indicated in this population to minimize errors in clinical decision making.