Clinical Decision Rules for Excluding Pulmonary Embolism
Authors: Giuliano Giusti, Anna Coerezza, Giulia Cernuschi
Journal: Annals of Internal Medicine (2012)

Letters17 January 2012Clinical Decision Rules for Excluding Pulmonary EmbolismGiuliano Giusti, MD, Anna Coerezza, MD, and Giulia Cernuschi, MDGiuliano Giusti, MDFrom Medicina II, Ospedale Luigi Sacco, Universita degli Studi di Milano 20157 44 Milan, Italy.Search for more papers by this author, Anna Coerezza, MDFrom Medicina II, Ospedale Luigi Sacco, Universita degli Studi di Milano 20157 44 Milan, Italy.Search for more papers by this author, and Giulia Cernuschi, MDFrom Medicina II, Ospedale Luigi Sacco, Universita degli Studi di Milano 20157 44 Milan, Italy.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-2-201201170-00024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read with great interest the article by Lucassen and colleagues (1) on clinical decision rules for excluding pulmonary embolism (PE). The authors concluded that clinical prediction rules and clinical judgment can safely exclude PE only when combined with d-dimer testing. The posttest probability that was considered safe to rule out PE was set at 2%, and the maximum upper confidence limit was 2.7% (1). We wonder whether this conclusion can be routinely applied to clinical practice.In most of the cited studies on PE diagnosis, negative clinical follow-up at 3 to 6 months or positive findings ...References1. Lucassen W, Geersing GJ, Erkens PM, Reitsma JB, Moons KG, Büller H, et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med. 2011;155:448-60. [PMID: 21969343] LinkGoogle Scholar2. Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, et al; PIOPED II Investigators. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317-27. [PMID: 16738268] CrossrefMedlineGoogle Scholar3. Perrier A, Roy PM, Sanchez O, Le Gal G, Meyer G, Gourdier AL, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005;352:1760-8. [PMID: 15858185] CrossrefMedlineGoogle Scholar4. Eyer BA, Goodman LR, Washington L. Clinicians' response to radiologists' reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT. AJR Am J Roentgenol. 2005;184:623-8. [PMID: 15671388] CrossrefMedlineGoogle Scholar5. van Beek EJ, Brouwerst EM, Song B, Stein PD, Oudkerk M. Clinical validity of a normal pulmonary angiogram in patients with suspected pulmonary embolism—a critical review. Clin Radiol. 2001;56:838-42. [PMID: 11895301] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Medicina II, Ospedale Luigi Sacco, Universita degli Studi di Milano 20157 44 Milan, Italy.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Decision Rules for Excluding Pulmonary Embolism: A Meta-analysis Wim Lucassen , Geert-Jan Geersing , Petra M.G. Erkens , Johannes B. Reitsma , Karel G.M. Moons , Harry Büller , and Henk C. van Weert Clinical Decision Rules for Excluding Pulmonary Embolism Wim Lucassen , Henk C. van Weert , and Harry Büller Metrics 17 January 2012Volume 156, Issue 2Page: 168-169KeywordsComputed axial tomographyDeath ratesHypoxiaIschemiaMorbidityPulmonary embolismRisk managementSpecificity ePublished: 17 January 2012 Issue Published: 17 January 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...