Diagnostic Strategies For Pulmonary Embolism Research Articles

Pulmonary embolism work-up in chronic obstructive pulmonary disease exacerbations: what is the best strategy for clinicians?

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural course of COPD, as they increase morbidity and mortality. Acute pulmonary embolism may mimic the symptoms of COPD exacerbations. However, the exact prevalence of pulmonary embolism in unexplained exacerbations of COPD is unclear based on the current data. This review provides a practical approach to patients with COPD complaining of worsening respiratory symptoms. A randomized clinical trial has shown that a routine pulmonary embolism diagnostic work-up does not improve care of patients with acute exacerbations of COPD. However, review of the recent literature suggests that a nonnegligible proportion of otherwise unexplained exacerbations of COPD may be caused by pulmonary embolism. To date, nevertheless, there are limited studies developing and validating clinical models that might aid in the identification of patients requiring additional tests for the diagnosis of pulmonary embolism. Until new evidence becomes available, we believe that a routine diagnostic strategy for pulmonary embolism is not appropriate for patients with acute exacerbations of COPD. Recommendations for routine pulmonary embolism diagnostic work-up necessitate further development of prognostic models and conduct of clinical trials that assess important health outcomes.

Diagnostic strategies for pulmonary embolism in COVID-19.

Diagnostic strategies for pulmonary embolism in COVID-19.

Safety of the Pulmonary Embolism Rule-Out Criteria Rule: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry.

The diagnostic strategy for pulmonary embolism (PE) includes a D-dimer test when PE probability is low or intermediate, but false positive D-dimer results are frequent and can result in an unnecessary computed tomography pulmonary angiogram. The PE rule-out criteria (PERC) rule excludes PE without D-dimer testing when pre-test probability is <15%. The aim of this study was to assess the safety of the PERC rule strategy in patients included in the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. This retrospective cohort study used data from the RIETE registry, an ongoing, international prospective registry of patients with objectively confirmed venous thromboembolism. The primary outcome was the failure rate of the PERC strategy, represented by the proportion of PERC-negative (PERC-N) patients with a PE included in the registry. Secondary outcomes were a comparison of the clinical characteristics, treatment strategy, and outcome of PERC-N versus PERC-positive (PERC-P) patients at 3 months. From 2001 to 2021, 49,793 patients with acute PE were enrolled in the RIETE registry. We included 48,903 in the final analysis after exclusion of 890 patients with an undetermined PERC status. Only 346 patients were PERC-N with a failure rate of 0.7% (95% confidence interval 0.6-0.8%). PERC-N patients presented more frequently with chest pain, but less often with dyspnea, syncope or hypotension. They had also sub-segmental or segmental PE more frequently, were more often treated with direct oral anticoagulants, and received mechanical or pharmacological thrombolysis less often. In addition, PERC-N patients had a lower incidence of recurrent deep vein thrombosis, major bleeding, and death attributed to PE during the 3-month follow-up. A low failure rate of the PERC rule was observed in the RIETE registry, thus supporting its use to safely identify patients with an unlikely probability of PE.

Pulmonary Embolism and Respiratory Deterioration in Chronic Cardiopulmonary Disease: A Narrative Review

Patients with chronic cardiopulmonary pathologies have an increased risk of developing venous thromboembolic events. The worsening of dyspnoea is a frequent occurrence and often leads patients to consult the emergency department. Pulmonary embolism can then be an exacerbation factor, a differential diagnosis or even a secondary diagnosis. The prevalence of pulmonary embolism in these patients is unknown, especially in cases of chronic heart failure. The challenge lies in needing to carry out a systematic or targeted diagnostic strategy for pulmonary embolism. The occurrence of a pulmonary embolism in patients with chronic cardiopulmonary disease clearly worsens their prognosis. In this narrative review, we study pulmonary embolism and chronic obstructive pulmonary disease, after which we turn to pulmonary embolism and chronic heart failure.

Translated article] Prognostic Significance of Findings on CTPA Supporting an Alternative Diagnosis to PE Among Patients Hospitalized for an Exacerbation of COPD: Predefined Subanalysis of the SLICE Trial

BackgroundAmong patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), the SLICE trial showed that the addition of an active diagnostic strategy for pulmonary embolism (PE) to usual care compared with usual care alone did not improve a composite set of health outcomes. The objective of this subanalysis was to determine the frequency and prognostic significance of findings on computed tomography pulmonary angiogram (CTPA) supporting an alternative diagnosis to PE. MethodsWe analyzed all patients randomized to the intervention in the SLICE trial who received a CTPA that did not show PE. We used multivariable logistic regression to assess the independent association between findings supporting an alternative diagnosis to PE and a composite of readmission for COPD or death within 90 days after randomization. ResultsAmong the 746 patients who were randomized, this subanalysis included 175 patients in the intervention group who received a CTPA that did not show PE. Eighty-four (48.0%) patients had acute bronchial infection, 13 (7.4%) had lung cancer, 10 (5.7%) had congestive heart failure, 8 (4.6%), 18 (10.3%) had other diagnoses, and 42 (24.0%) had a normal CTPA. In multivariable analysis, findings supporting an alternative diagnosis to PE were not significantly associated with the primary outcome (odds ratio: 0.64; 95% confidence interval: 0.30–1.38; P=0.26). ConclusionsAmong patients hospitalized for an exacerbation of COPD, CTPA identified an alternative diagnosis in 76% of the patients. However, specific management of these patients was not associated with improved outcomes within 90 days after randomization.

Significado pronóstico de los diagnósticos alternativos a la TEP hallados en la tomografía computarizada de tórax de pacientes ingresados por agudización de EPOC: subanálisis predefinido del ensayo SLICE

BackgroundAmong patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), the SLICE trial showed that the addition of an active diagnostic strategy for pulmonary embolism (PE) to usual care compared with usual care alone did not improve a composite set of health outcomes. The objective of this subanalysis was to determine the frequency and prognostic significance of findings on computed tomography pulmonary angiogram (CTPA) supporting an alternative diagnosis to PE. MethodsWe analyzed all patients randomized to the intervention in the SLICE trial who received a CTPA that did not show PE. We used multivariable logistic regression to assess the independent association between findings supporting an alternative diagnosis to PE and a composite of readmission for COPD or death within 90 days after randomization. ResultsAmong the 746 patients who were randomized, this subanalysis included 175 patients in the intervention group who received a CTPA that did not show PE. Eighty-four (48.0%) patients had acute bronchial infection, 13 (7.4%) had lung cancer, 10 (5.7%) had congestive heart failure, 8 (4.6%), 18 (10.3%) had other diagnoses, and 42 (24.0%) had a normal CTPA. In multivariable analysis, findings supporting an alternative diagnosis to PE were not significantly associated with the primary outcome (odds ratio: 0.64; 95% confidence interval: 0.30-1.38; P=0.26). ConclusionsAmong patients hospitalized for an exacerbation of COPD, CTPA identified an alternative diagnosis in 76% of the patients. However, specific management of these patients was not associated with improved outcomes within 90 days after randomization.

Annals for Educators - February 2022.

Annals for Educators - February 2022.

Ruling out pulmonary embolism across different subgroups of patients and healthcare settings: protocol for a systematic review and individual patient data meta-analysis (IPDMA)

BackgroundDiagnosing pulmonary embolism in suspected patients is notoriously difficult as signs and symptoms are non-specific. Different diagnostic strategies have been developed, usually combining clinical probability assessment with D-dimer testing. However, their predictive performance differs across different healthcare settings, patient subgroups, and clinical presentation, which are currently not accounted for in the available diagnostic approaches.MethodsThis is a protocol for a large diagnostic individual patient data meta-analysis (IPDMA) of currently available diagnostic studies in the field of pulmonary embolism. We searched MEDLINE (search date January 1, 1995, till August 25, 2016) to retrieve all primary diagnostic studies that had evaluated diagnostic strategies for pulmonary embolism. Two authors independently screened titles, abstracts, and subsequently full-text articles for eligibility from 3145 individual studies. A total of 40 studies were deemed eligible for inclusion into our IPDMA set, and principal investigators from these studies were invited to participate in a meeting at the 2017 conference from the International Society on Thrombosis and Haemostasis. All authors agreed on data sharing and participation into this project. The process of data collection of available datasets as well as potential identification of additional new datasets based upon personal contacts and an updated search will be finalized early 2018. The aim is to evaluate diagnostic strategies across three research domains: (i) the optimal diagnostic approach for different healthcare settings, (ii) influence of comorbidity on the predictive performance of each diagnostic strategy, and (iii) optimize and tailor the efficiency and safety of ruling out PE across a broad spectrum of patients with a new, patient-tailored clinical decision model that combines clinical items with quantitative D-dimer testing.DiscussionThis pre-planned individual patient data meta-analysis aims to contribute in resolving remaining diagnostic challenges of time-efficient diagnosis of pulmonary embolism by tailoring available diagnostic strategies for different healthcare settings and comorbidity.Systematic review registrationProspero trial registration: ID 89366.

Interest of chest X-ray in tailoring the diagnostic strategy in patients with suspected pulmonary embolism.

Current diagnostic strategies for pulmonary embolism rely on the sequential use of noninvasive diagnostic tests including ventilation-perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA). V/Q scan remains criticized because of a high proportion of nondiagnostic test results, especially when the chest X-ray (CXR) is abnormal. The present study assesses whether CXR results have an impact on the conclusiveness of a noninvasive diagnostic strategy of pulmonary embolism based on the combination of pretest probability, compression ultrasonography, V/Q scan, and CTPA. Patients suspected of having pulmonary embolism were managed according to a validated diagnostic strategy. All patients underwent a CXR within 24 h of the suspicion of pulmonary embolism. CXR results were correlated to strategy conclusiveness, as assessed by the rate of required CTPA as per the diagnostic algorithm. Two hundred and twenty-three patients were retrospectively analyzed. CXRs were considered as normal in 108 (48%) patients and abnormal in 115 (52%) patients. According to the diagnostic algorithm, a CTPA was required to reach a diagnostic conclusion in 11 (10%) patients of the normal CXR group, and in 14 (12%) patients of the abnormal CXR group (P > 0.05). In this study, the presence of CXR abnormalities did not have an impact on the conclusiveness of a diagnostic strategy of pulmonary embolism based on V/Q scan. CXR abnormalities should likely not be regarded as a contraindication to the use of V/Q scan in patients with suspected pulmonary embolism.

Effects of impaired renal function on levels and performance of D-dimer in patients with suspected pulmonary embolism.

Clinical probability and D-dimer measurement play an essential role in the non-invasive diagnostic strategies for pulmonary embolism (PE). PE can be ruled out without further imaging in patients with non-high clinical probability and negative D-dimer. D-dimer level is increased in patients with renal impairment. Whether its diagnostic usefulness is maintained in these patients is not well determined. We aimed to evaluate the effects of renal impairment on diagnostic performances of D-dimer in patients with suspected PE. A retrospective analysis of 1,625 patients with suspected PE included in a multicentre prospective study was performed. D-dimer levels and percentages of patients with a negative D-dimer were compared between three subgroups according to glomerular filtration rate (GFR) estimated by the MDRD formula: ≥90 ml/min (normal renal function), 60-89 ml/min (mild renal impairment), 30-59 ml/min (moderate renal impairment). D-dimer levels increased and the proportion of negative D-dimer decreased significantly according to renal status: 46% negative D-dimer in patients with normal GFR, 31% in patients with mild renal impairment, 11% in those with moderate renal impairment, corresponding to number of patients needed to test to obtain one negative test of 2.2, 3.2 and 9, respectively. In conclusion, the clinical usefulness of D-dimer decreases with renal impairment. However, PE can still be ruled out by negative D-dimer in a substantial proportion of patients with non-high clinical probability, avoiding exposure to contrast media.

Value of venous color flow duplex scan as initial screening test for geriatric inpatients with clinically suspected pulmonary embolism

AimThe contribution of lower extremity venous duplex scan to the diagnostic strategy for pulmonary embolism has been demonstrated by many authors. However, the positive diagnostic value of this noninvasive test in clinically suspected pulmonary embolism is not very high (10%–18%). Since thromboembolic risks increase considerably in hospitalized patients with advanced age, this study aims to determine the importance of lower extremity venous color flow duplex scan in this particular subgroup of patients with clinically suspected pulmonary embolism. The effects of clinical presentation and risk factors on the results of duplex scan have been also studied.MethodsBetween July 2007 and January 2010, 95 consecutive Lebanese geriatric (≥60 years of age) inpatients with clinically suspected pulmonary embolism assessed in an academic tertiary-care center for complete lower extremity venous color flow duplex scan were retrospectively reviewed. Age varied between 60 and 96 years (mean, 79.9 years). Forty patients were males and 55 females. Absence of compressibility was the most important criteria for detecting acute venous thrombosis.ResultsOut of 95 patients, 33 patients (34.7%) were diagnosed with recent deep venous thrombosis of lower extremities (14 proximal and 19 distal) using complete venous ultrasound. Nine of these 33 patients (27.2%) had a history of venous thromboembolism and eleven (33.3%) presented with edema of lower extremities. A total of 28 patients (84.8%) with positive duplex scan had associated risk factors for venous thromboembolism.ConclusionLower extremity venous color flow duplex scan appears to be a reasonable initial screening test in the diagnostic algorithm of pulmonary embolism in geriatric inpatients with clinically suspected pulmonary embolism. This is particularly true in patients with a history of venous thromboembolism, in patients with a clinical presentation suggesting venous thrombosis, in uremic patients and in patients with altered general and mental status who are not candidates for chest computed tomography.

Cost-Effective Diagnostic Strategies in Patients With a High, Intermediate, or Low Clinical Probability of Pulmonary Embolism

Rapid quantitative D-dimer assays (DD), lower extremity venous duplex ultrasonography (US), and multislice computed tomographic (CT) angiography have been shown to have adequate sensitivities and specificities for diagnostic purpose. The purpose of this study was to evaluate cost-effectiveness of diagnostic strategies for pulmonary embolism (PE) in patients with a high, intermediate, or low clinical probability of PE. A formal cost-effectiveness analysis for the diagnosis of PE was performed. The main outcome measure for effectiveness was 3-month expected survival. The strategy of DD followed by CT was cost-effective and had the lowest cost per life saved for all patients suspected with PE. The conventional strategy including ventilation and perfusion lung scanning followed by pulmonary angiography (PA) or CT was not cost-effective. The leg US after CT was not also cost-effective. In clinical practice, the individual patient's condition should be considered when choosing appropriate diagnostic tests.

P3– Existing clinical assessment tools and diagnostic strategies for pulmonary embolism

P3– Existing clinical assessment tools and diagnostic strategies for pulmonary embolism

The survey of the epidemiology of pulmonary embolism in hospitals of different medical levels in China.

Objective To investigate the diagnosis and treatment of pulmonary embolism(PE)in hospitals of different medical levels and further explore the diagnostic strategy for PE in primary hospitals.Method The clinical data from twenty hospitals of different medical levels in 8 provisions of China were retrospectively investigated using stratified cluster random sampling method and questionnaire form during may 2001 to may 2008.The questionnaire included:the general situation,the underlying diseases and triggering factors(risk factors),clinical manifestations,examination findings,rate of misdiagnosis and correct diagnosis,treatment and prognosis.Inclusion criteria:age≥18 years,passed pulmonary angiography or enhanced CT to confirm the diagnosis of PE.The data was input the Epidata database.Comparison of the rate of count data used chi-square test.Results(1)A total of 302 collected from 20 hospitals including 11 tertiary hospitals(n = 204)and 9 second hospitals(n = 98).(2)Of 12 risk factors,deep vein thrombosis and surgical operation accounted for 23.4%,16.2%,respectively.Of 22 clinical manifestations,the incidences of chest tightness,dyspena,palpitations,chest pain,shortness of breath and tachycardia accounted for over 40%in all.Laboratory examinations showed the percentage of blood Ddimer over 500 μg/L was 74.6%and the percentages of serum enzyme and creatine kinase isoenzyme were 50.1%and 0%,respectively,on ECG,the incidence of sinus tachycardia,low or inverted T waves of V1 to V6 leads,ST segment depression,complete or incomplete right bundle branch block and typical SⅠ QⅢ TⅢ were 55.4%,35.7%,27.2%,26.9%and 25.9%,respectively.On chest X-ray,the incidence of increase in lung markings,the shadow of the lungs,pleural effusion,prominent pulmonary artery segment,right pulmonary artery widened,regional lung atelectasis and pulmonary blood vessels sparse were 46.4%,36.1%,24.2%,24.2%,17.5%,9.3%,and 7.7%,respectively.The echocardiography showed the incidence of pulmonary hypertension,right ventricular dilation,lower right ventricular wall motion and pulmonary artery thrombosis were 66.7%,50.7%,16.4%and 6.8%,respectively.(3)The misdiagnosis was made in 55(18.2%)of 66 patients.Of them,28 patients were misdiagnosed as coronary heart disease and 11 patients were misdiagnosed as pneumonia.(4)In the hospitals of secondary medical level the diagnosis depended mainly upon the clinical manifestions of patients and clinical examinations(89.8%).In the tertiary hospitals,the diagnosis of PE was made by using enhanced CT(48.0%),an integrated clinical approach(22.1%),pulmonary ventilation/perfusion scan (12.3%),and pulmonary angiography(10.8%).(5)In the tertiary and secondary hospitals,the percentages of thrombolytic therapy were 17.3%and 14.7%,respectively,(P＞0.05).The percentage of anticoagulant therapy is 63.3%and 77.9%(P＜0.01).The percentage of oral warfarin for at least 3 months were 61.2%and 76.0%(P＜0.01).(6)The anticoagulant or thrombolytic intervention showed higher therapeutic efficiency than the non-intervention(83.6%vs.23.3%,P＜0.01).The mortality of the therapeutic group was lower than that of non-intervention group(9.0%vs.30.0%,P＜0.01).Conclusions PE has no specific symptom and easily leads to misdiagnosis and mistreatment.The diagnosis of PE in the secondary hospitals depended? on general inspection,whereas in the tertiary hospitals,on enhanced CT.Effective intervention can significantly improve outcomes,and standardized guidelines of the diagnosis and treatment of PE should be set in our country. Key words: Pulmonary embolism; Diagnosis; Treatment; Hospitals of different medical levels; Epidemiology

Contemporary approach to the diagnosis of non-massive pulmonary embolism

Minimally invasive diagnostic strategies for pulmonary embolism are in constant evolution, integrating new diagnostic tools along with the better use of clinical information. In the past year, several reports have provided more data on the value of clinical signs and symptoms for diagnosing pulmonary embolism and improved clinical prediction rules for pulmonary embolism. Among the diagnostic tools, the use of multislice computed tomography of the chest received further validation, whereas the yield of bedside tests, such as the D-dimer test or alveolar dead-space measurement, have been further investigated. Furthermore, data linking good outcomes with appropriate diagnostic strategies in patients with suspected pulmonary embolism were reported this year for the first time. These new data allow a more evidence-based and cost-effective approach to patients with suspected non-massive pulmonary embolism. Multislice computed tomography is replacing other imaging tests. More research should be performed on the role of lower limb venous compression ultrasonography, and on how to select patients in whom pulmonary embolism should be suspected and investigated.

Systematic Review and Meta-Analysis of Strategies for the Diagnosis of Suspected Pulmonary Embolism

Objective To assess the likelihood ratios of diagnostic strategies for pulmonary embolism and to determine their clinical application according to pretest probability. Data sources Medline, Embase, and Pascal Biomed and manual search for articles published from January 1990 to September 2003. Study selection Studies that evaluated diagnostic tests for confirmation or exclusion of pulmonary embolism. Data extracted Positive likelihood ratios for strategies that confirmed a diagnosis of pulmonary embolism and negative likelihood ratios for diagnostic strategies that excluded a diagnosis of pulmonary embolism. Data synthesis 48 of 1012 articles were included. Positive likelihood ratios for diagnostic tests were: high probability ventilation perfusion lung scan 18.3 (95% confidence interval 10.3 to 32. 5) , spiral computed tomography 24. 1 (12. 4 to 46. 7) , and ultrasonography of leg veins 16. 2 (5. 6 to 46. 7). In patients with a moderate or high pretest probability, these findings are associated with a greater than 85% post-test probability of pulmonary embolism. Negative likelihood ratios were: normal or near normal appearance on lung scan 0. 05 (0. 03 to 0. 10) , a negative result on spiral computed tomography along with a negative result on ultrasonography 0. 04 (0. 03 to 0. 06) , and a D-dimer concentration 500 μg/L measured by quantitative enzyme linked immunosorbent assay 0.08 (0.04 to 0. 18) . In patients with a low or moderate pretest probability, these findings were associated with a post-test probability of pulmonary embolism below 5% . Spiral computed tomography alone, a low probability ventilation perfusion lung scan, magnetic resonance angiography, a quantitative latex D-dimer test , and haemagglutination D-dimers had higher negative likelihood ratios and can therefore only exclude pulmonary embolism in patients with a low pretest probability. Conclusions The accuracy of tests for suspected pulmonary embolism varies greatly, but it is possible to estimate the range of pretest probabilities over which each test or strategy can confirm or rule out pulmonary embolism.

Diagnosing pulmonary embolism in outpatients with clinical assessment, D-Dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study

Purpose To evaluate a diagnostic strategy for pulmonary embolism that combined clinical assessment, plasma D-dimer measurement, lower limb venous ultrasonography, and helical computed tomography (CT). Methods A cohort of 965 consecutive patients presenting to the emergency departments of three general and teaching hospitals with clinically suspected pulmonary embolism underwent sequential noninvasive testing. Clinical probability was assessed by a prediction rule combined with implicit judgment. All patients were followed for 3 months. Results A normal D-dimer level (<500 μg/L by a rapid enzyme-linked immunosorbent assay) ruled out venous thromboembolism in 280 patients (29%), and finding a deep vein thrombosis by ultrasonography established the diagnosis in 92 patients (9.5%). Helical CT was required in only 593 patients (61%) and showed pulmonary embolism in 124 patients (12.8%). Pulmonary embolism was considered ruled out in the 450 patients (46.6%) with a negative ultrasound and CT scan and a low-to-intermediate clinical probability. The 8 patients with a negative ultrasound and CT scan despite a high clinical probability proceeded to pulmonary angiography (positive: 2; negative: 6). Helical CT was inconclusive in 11 patients (pulmonary embolism: 4; no pulmonary embolism: 7). The overall prevalence of pulmonary embolism was 23%. Patients classified as not having pulmonary embolism were not anticoagulated during follow-up and had a 3-month thromboembolic risk of 1.0% (95% confidence interval: 0.5% to 2.1%). Conclusion A noninvasive diagnostic strategy combining clinical assessment, D-dimer measurement, ultrasonography, and helical CT yielded a diagnosis in 99% of outpatients suspected of pulmonary embolism, and appeared to be safe, provided that CT was combined with ultrasonography to rule out the disease.

Integrating complete lower limb venous ultrasound into diagnostic strategies for pulmonary embolism: a cost-effectiveness analysis

Integrating complete lower limb venous ultrasound into diagnostic strategies for pulmonary embolism: a cost-effectiveness analysis -

Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism.

A limited ultrasound (US) confined to the popliteal and femoral veins is usually performed to detect deep vein thrombosis (DVT) in patients with clinically suspected acute pulmonary embolism (PE). Our objective was to assess the diagnostic accuracy of complete lower limb US examining both the proximal and distal veins in this setting. In this prospective study, 210 consecutive patients were included. Complete US was performed by independent operators and compared blindly with a reference strategy combining clinical probability, ventilation perfusion scan and pulmonary angiography to a three-month clinical follow-up. Simultaneously, VIDAS D-dimer (DD) assay and helical computed tomography (HCT) of the lungs were assessed independently and blindly. PE was present in 74 patients (35%). Complete US detected DVT in 91 patients (43%), proximal in 51 and distal in 40. Sensitivity and specificity with a 0.95 confidence interval were respectively 0.93 [0.85 - 0.97] and 0.84 [0.77 - 0.89]. Limited US detected DVT in only 46 patients (22%). Sensitivity and specificity were respectively 0.55 [0.44 - 0.66] and 0.96 [0.92 - 0.98]. For DD they were 0.92 [0.83 - 0.96] and 0.24 [0.17 - 0.32] and for HCT 0.84 [0.73 - 0.90] and 0.87 [0.80 - 0.92]. Complete lower limb US has higher sensitivity and capacity to exclude PE than limited US, but a slightly lower specificity. Complete US results also compared favourably with those of HCT and DD. The utility of including this method in diagnostic strategies for PE needs to be assessed in cost-effectiveness analysis and in outcome studies.

More Data on Spiral CT and Diagnosis of Pulmonary Embolism

Increasingly, spiral CT is incorporated into diagnostic strategies for pulmonary embolism (PE). In this multicenter French study, researchers examined outcomes with the following algorithm: All patients with suspected PE underwent clinical estimation of pretest probability of PE (using a published scheme), spiral CT, and leg ultrasound (US). Patients with negative CT and US and …