Diagnosis of pulmonary embolism in hospitalized patients: retrospective survey of an institutional standard

¹ Service de Pneumologie et d'Oncologie Thoracique
² Service de Radiologie, CHI Poissy-St Germain, St Germain-en-Laye, France

^* To whom correspondence should be addressed. E-mail: stephanejouveshomme{at}chi-psg.com.

	Abstract

To assess the safety and implementation of a diagnostic strategy in hospitalized patients with suspected acute pulmonary embolism (PE).

A diagnostic strategy was established and implemented in a general hospital. A retrospective cohort study including 400 consecutive inpatients was performed in order to assess the appropriateness of the diagnostic management and the incidence of symptomatic venous thromboembolic events (VTE) during follow-up.

PE was confirmed in 116 patients (29%). The incremental value of adding compression ultrasonography (CUS) to multidetector-row CT (MDCT) for the diagnosis of PE was 8.6%. PE was appropriately excluded in 169 patients (42%) because of a normal lung scan (n=34), a negative MDCT providing an alternative diagnosis (n=94), a negative MDCT and CUS (n=41). During follow-up, VTE occurred in 3.5% patients. The almost unique cause of inappropriate management was the absence of further workup after a MDCT negative for PE providing no alternative diagnosis (n=115). Inappropriate management was associated with a non significant increased risk of VTE (7.2%)

A frontline diagnostic work-up based on pulmonary MDCT associated with a CUS of the leg veins is effective and more sensitive than pulmonary MDCT alone in ruling out PE.

This article has been cited by other articles:

				O. Sanchez, B. Planquette, and G. Meyer Update on acute pulmonary embolism Eur. Respir. Rev., September 1, 2009; 18(113): 137 - 147. [Full Text] [PDF]