Non-invasive diagnosis of pulmonary embolism.
Chest. 2010 Aug 19;
Authors: Salaun PY, Couturaud F, LE Duc-Pennec A, Lacut K, LE Roux PY, Guillo P, Pennec PY, Cornily JC, Leroyer C, LE Gal G
AbstractBackground We designed a simple and integrated diagnostic algorithm for acute pulmonary embolism (PE). Diagnosis was based on clinical probability assessment, plasma D-Dimer testing, then sequential testing to include lower limb venous compression ultrasonography, ventilation perfusion lung scan and chest multi-detector computed tomography (MDCT). Methods We included 321 consecutive patients presenting at the University Hospital of Brest, Brest, France with clinically suspected PE and positive D-dimer or high clinical probability. Patients in whom venous thromboembolism was deemed absent were not given anticoagulants and were followed up for 3 months. Results Detection of deep vein thrombosis by ultrasonography established the diagnosis of PE in 43 (13%). Lung scan associated with clinical probability was diagnostic in 243 (76%) of the remaining patients. MDCT scan was required in only 35 (11%) of the patients. The 3- month thromboembolic risk in patients not given anticoagulants, based on the results of the diagnostic protocol, was 0.53% (95% CI 0.09-2.94). Conclusions A diagnostic strategy combining clinical assessment, D-dimer, ultrasonography, and lung scan gave a non-invasive diagnosis in the vast majority of outpatients with suspected pulmonary embolism, and appeared to be safe.
PMID: 20724733 [PubMed - as supplied by publisher]