Abstract
Introduction: Evaluation of chest pain in the Emergency Department is common. Significant resources are expended looking for dangerous etiologies. The D-dimer is frequently utilized but can be positive in a variety of pathologic and non-pathologic states, including pneumonia. We anticipated that patients who had pneumonia on chest x-ray and also a positive D-dimer would have a low likelihood of also having pulmonary embolism. We hoped to define this patient population as low risk of having PE in the setting of pneumonia with the purpose of limiting unnecessary CT angiographies.
Highlights
Evaluation of chest pain in the Emergency Department is common
We identified a total of 151 patients who had an initial chest x-ray with evidence of pneumonia
Racial makeup of the study population is Table 1. Of these 151 patients, 7 patients were later found to have a pulmonary embolism while 144 had negative work ups for pulmonary embolism
Summary
Evaluation of chest pain in the Emergency Department is common. We anticipated that patients who had pneumonia on chest x-ray and a positive D-dimer would have a low likelihood of having pulmonary embolism. Accounting for about 5% of all ED visits, significant resources are expended looking for dangerous causes of chest pain [1]. During the initial ED evaluation of acutely-ill patients with chest pain or difficulty breathing vital signs, basic laboratory work up, and simple imaging with chest x-rays often guide further workup and management. The D-dimer is a common (and often controversial) lab test utilized for screening for pulmonary embolism when the initial diagnosis is not apparent [2]. Recent studies have shown that pneumonia is a common
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