The present study was supported by grants from the Swiss National Research Foundation (32-43439.95), and the Royal College of Physicians and Surgeons of Canada (96/4-D11).
Contribution of noninvasive evaluation to the diagnosis of pulmonary embolism in hospitalized patients
Article first published online: 25 DEC 2001
European Respiratory Journal
Volume 13, Issue 6, pages 1365–1370, June 1999
How to Cite
Miron, M.-J. , Perrier, A., Bounameaux, H. , De Moerloose, P. , Slosman, D.o., Didier, D. and Junod, A. (1999), Contribution of noninvasive evaluation to the diagnosis of pulmonary embolism in hospitalized patients. European Respiratory Journal, 13: 1365–1370. doi: 10.1034/j.1399-3003.1999.13f22.x
- Issue published online: 25 DEC 2001
- Article first published online: 25 DEC 2001
- d-dimer ;
- pulmonary embolism;
- venous ultrasonography;
- ventilation/perfusion lung scan
The effectiveness of new diagnostic tools for suspected pulmonary embolism (PE), such as clinical probability assessment, plasma d-dimer (DD) measurement and lower limb venous compression ultrasonography (US), has not been specifically studied in patients with a suspected PE occurring during hospital stay.
This study applied a sequential, decision analysis-based strategy adding these instruments to a ventilation/perfusion lung scan in a cohort of 114 consecutive inpatients clinically suspected of PE in order to establish in how many patients a pulmonary angiogram could thereby be avoided.
A definitive diagnosis could be established by the noninvasive protocol in 61% of these patients: normal/near-normal lung scan, 14%; high probability lung scan, 19%; clinical probability combined with lung scan result, 18%; and US, 8%. Specificity of DD was only 7% and contributed to the exclusion of PE in only two patients. Pulmonary angiography was required in 39% of patients. The 3-month thromboembolic risk in patients in whom PE was excluded by the diagnostic process was 0% (95% confidence interval 0–4.9%).
In conclusion, a noninvasive work-up for suspected pulmonary embolism is effective in hospitalized patients, allowing to forego angiography in 61% of them, and it appears to be safe, although this should be further investigated. In contrast to outpatients, d-dimer measurement appears to be useless in hospitalized patients.