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Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators |
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| Authors: | Stein Paul D Woodard Pamela K Weg John G Wakefield Thomas W Tapson Victor F Sostman H Dirk Sos Thomas A Quinn Deborah A Leeper Kenneth V Hull Russell D Hales Charles A Gottschalk Alexander Goodman Lawrence R Fowler Sarah E Buckley John D;PIOPED II investigators |
| Institution: | a Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich b Department of Medicine, Wayne State University, Detroit, Mich c Department of Radiology, Washington University, St. Louis, Mo d Department of Medicine, University of Michigan, Ann Arbor e Department of Surgery, University of Michigan, Ann Arbor f Department of Medicine, Duke University, Durham, NC g Office of the Dean, Weill Cornell Medical College, New York, NY h Office of the Executive Vice President, Methodist Hospital, Houston, Tex i Department of Radiology, Weill Cornell Medical College, New York, NY j Department of Medicine, Massachusetts General Hospital, Boston k Harvard Medical School, Boston, Mass l Department of Medicine, Emory University, Atlanta, Ga m Department of Medicine, University of Calgary, Calgary, Alberta, Canada n Department of Radiology, Michigan State University, East Lansing o Department of Radiology, Medical College of Wisconsin, Milwaukee p The Biostatistics Center, Department of Epidemiology and Biostatistics, George Washington University, Rockville, Md q Department of Medicine, Henry Ford Hospital, Detroit, Mich. |
| Abstract: | PurposeTo formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on randomized trials.MethodsDiagnostic management recommendations were formulated based on results of the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) and outcome studies.ResultsThe PIOPED II investigators recommend stratification of all patients with suspected pulmonary embolism according to an objective clinical probability assessment. D-dimer should be measured by the quantitative rapid enzyme-linked immunosorbent assay (ELISA), and the combination of a negative D-dimer with a low or moderate clinical probability can safely exclude pulmonary embolism in many patients. If pulmonary embolism is not excluded, contrast-enhanced computed tomographic pulmonary angiography (CT angiography) in combination with venous phase imaging (CT venography), is recommended by most PIOPED II investigators, although CT angiography plus clinical assessment is an option. In pregnant women, ventilation/perfusion scans are recommended by many as the first imaging test following D-dimer and perhaps venous ultrasound. In patients with discordant findings of clinical assessment and CT angiograms or CT angiogram/CT venogram, further evaluation may be necessary.ConclusionThe sequence for diagnostic test in patients with suspected pulmonary embolism depends on the clinical circumstances. |
| Keywords: | Pulmonary embolism Venous thromboembolism Computed tomographic angiography D-dimer Pulmonary scintigraphy Clinical assessment |
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