A Simple, Safe Approach to Decrease Use of CT for Pulmonary Embolism

An algorithm combining a D-dimer threshold of 1000 and absence of three Wells score risk factors safely excluded PE.

Pulmonary embolism (PE) is one of the most vexing diagnoses in emergency medicine — a disease with protean symptoms that can be suddenly fatal. Currently, computed tomography pulmonary angiography (CTPA) is overused, resulting in overdiagnosis of small, clinically inconsequential emboli and excess radiation exposure.

These authors prospectively tested a new diagnostic algorithm (YEARS) combining d-dimer concentration with three criteria of the Wells score: signs of deep vein thrombosis (DVT), hemoptysis, and PE the most likely diagnosis. Patients with none of these criteria and a d-dimer level <1000 ng/mL and patients with at least one of the criteria and a d-dimer level <500 ng/mL were considered not to have PE and were managed without CTPA…

Reviewing Author

Daniel M. Lindberg, MD

Disclosures

RoyaltiesUpToDate

Grant/Research SupportEunice Kennedy Shriver National Institute of Child Health and Human Development; MINDSOURCE

Editorial BoardsThe Quarterly Update: Reviews of Current Child Abuse Medical Research; Child Abuse & Neglect: The International Journal

Leadership Positions in Professional SocietiesThe Helfer Society (Executive Committee Member)