ACP: What to Do for Suspected Pulmonary Embolism
(HealthDay News) — Best practice advice on diagnosis of suspected pulmonary embolism (PE) is provided for clinicians in clinical guidelines from the American College of Physicians (ACP). The guidelines were published online September 29 in the Annals of Internal Medicine.
Ali S. Raja, MD, from Massachusetts General Hospital in Boston, and colleagues provide practical advice for the evaluation of patients with suspected acute PE based on best available evidence and recent guidelines.
The researchers note that in order to estimate pretest probability of PE, clinicians should use validated clinical prediction rules. In patients with low pretest probability of PE and who meet all PE Rule-Out Criteria, clinicians should not obtain D-dimer measurements or imaging studies. In patients with an intermediate pretest probability of PE or with a low pretest probability who do not meet all PE Rule-Out Criteria, clinicians should obtain high-sensitivity D-dimer measurement as the initial diagnostic test. For patients older than 50 years, age-adjusted D-dimer thresholds should be used. In patients with a D-dimer level below the age-adjusted cut-off, clinicians should not obtain any imaging studies. In patients with high pretest probability of PE, clinicians should obtain imaging with computed tomography pulmonary angiography.
"ACP's advice is designed to help physicians identify patients for whom a PE is so unlikely that they need no further testing, for whom plasma D-dimer testing can provide additional risk stratification, and for whom imaging is indicated because of their high risk and clinical presentation," Wayne J. Riley, MD, MPH, president of the ACP, said in a statement.