TY - JOUR
T1 - Diagnostic Pathways in Acute Pulmonary Embolism
T2 - Recommendations of The PIOPED II Investigators
AU - Stein, Paul D.
AU - Woodard, Pamela K.
AU - Weg, John G.
AU - Wakefield, Thomas W.
AU - Tapson, Victor F.
AU - Sostman, H. Dirk
AU - Sos, Thomas A.
AU - Quinn, Deborah A.
AU - Leeper, Kenneth V.
AU - Hull, Russell D.
AU - Hales, Charles A.
AU - Gottschalk, Alexander
AU - Goodman, Lawrence R.
AU - Fowler, Sarah E.
AU - Buckley, John D.
PY - 2006/12
Y1 - 2006/12
N2 - Purpose: To formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on randomized trials. Methods: Diagnostic management recommendations were formulated based on results of the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) and outcome studies. Results: The 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. Conclusion: The sequence for diagnostic test in patients with suspected pulmonary embolism depends on the clinical circumstances.
AB - Purpose: To formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on randomized trials. Methods: Diagnostic management recommendations were formulated based on results of the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) and outcome studies. Results: The 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. Conclusion: The sequence for diagnostic test in patients with suspected pulmonary embolism depends on the clinical circumstances.
KW - Clinical assessment
KW - Computed tomographic angiography
KW - D-dimer
KW - Pulmonary embolism
KW - Pulmonary scintigraphy
KW - Venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=33947694585&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2006.05.060
DO - 10.1016/j.amjmed.2006.05.060
M3 - Article
C2 - 17145249
AN - SCOPUS:33947694585
SN - 0002-9343
VL - 119
SP - 1048
EP - 1055
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 12
ER -