A Logical Approach to the Diagnosis of Pulmonary Embolism

Accuracy of Screening for Pulmonary Embolism in the Emergency Room

“…We have relied upon lung scanning in assigning most of our patients to high and low probability categories. This is an accur ate reflection of clinical practice at this in stitution, where the statistical limitations of the technique have been described in detail compared to pulmonary arteriography [4], Clearly, an error rate even twice that docu mented for this institution would not sub stantially alter the trends (or lack thereof) that we have observed. Furthermore, the in tent of this study was not to assess the utility of historical, clinical, and laboratory find ings in confirming the diagnosis of pulmon ary embolism, but rather to identify factors which might, singly or in combination, sug gest that the patient be assigned to a high probability category which should be inves tigated further as an inpatient.…”

“…High probability1 Low probability n % n % Total 13 100 24 100 Male 7 54 8 35 Female 6 46 16 65 Lower extremity thrombophlebitis, active 62 46 8 33 Chronic venous insufficiency 52 39 10 42 Congestive heart failure 43 31 4 17 Prolonged bed rest 3 23 4 17 Chronic obstructive pulmonary disease 33 23 8 33 Pulmonary embolism in past 3* 23 5 21 Pelvic disease or surgery 2 15 8 33 Lower extremity trauma or surgery, > 6 months past 2 15 4 17 Lower extremity trauma or surgery, < 6 months past 2 15 4 17 Cancer, diagnosis known 1 8 2 8 Estrogen medication 0 0 2 8 Postpartum, < 6 months 0 0 1 4 tion and perfusion lung scans interpreted as diag nostic or 'high probability' by our institution's published criteria [4], 3 on the basis of suggestive lung scans confirmed by positive pulmonary arte riograms, and 2 on the basis of right heart cathe terization performed in the intensive care unit, both with recent histories of documented pulmonary emboli. These 13 patients constitute the popula tion we considered to be in the high probability category for having suffered pulmonary embolism.…”