Rational diagnosis of pulmonary embolism (RADIA PE) in symptomatic outpatients with suspected PE: an improved strategy to exclude or diagnose venous thromboembolism by the sequential use of a clinical model, rapid ELISA D-dimer test, perfusion lung scan, ultrasonography, spiral CT, and pulmonary angiography.

Abstract

A prospective management decision analysis for the exclusion and diagnosis of pulmonary embolism (PE) based on pre-test clinical probability (PCP) estimation for PE, a rapid ELISA D-dimer test, perfusion lungscan (P-scan), CUS, spiral CT, and pulmonary angiography is proposed. The modified PCP model for PE of Wells et al. allows reasonably accurate classification of patients with no, low, moderate, and high probability for PE. The combined rational use of the evidence-based noninvasive imaging techniques P-scan, CUS, and spiral CT with the rapid ELISA D-dimer test and PCP will reduce the need for invasive pulmonary angiography to perhaps 10 to 15% of patients, who initially presented with suspected PE. A Rational Diagnosis of Pulmonary Embolism (RADIA PE) model is proposed for testing in a large multicenter study of patients with suspected PE.