Better Care for Patients with Suspected Pulmonary Embolism
Authors: Harold C. Sox
Journal: Annals of Internal Medicine (2006)

Editorials7 February 2006Better Care for Patients with Suspected Pulmonary EmbolismHarold C. Sox, MD, EditorHarold C. Sox, MD, EditorSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-3-200602070-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The diagnosis and treatment of pulmonary embolism engage the internist as few other diseases do, for many good reasons. Physicians often miss the diagnosis (1). The mortality rate for untreated pulmonary embolism is quite high (2, 3) and is much lower when the disorder is correctly treated (4). However, treatment-related bleeding carries a substantial fatality rate (5). Pulmonary angiography, still the definitive test, is inconvenient to do at night, and the sensitivity of noninvasive imaging tests is still too low to rule out disease when clinical suspicion is high (6).The medical literature contains 2 lines of inquiry regarding the ...References1. Uhland II, Goldberg LM. Pulmonary embolism: a commonly missed clinical entity. Dis Chest. 1964;45:533-6. [PMID: 14147480] CrossrefMedlineGoogle Scholar2. Barritt DW, Jordan SC. Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. Lancet. 1960;1:1309-12. [PMID: 13797091] CrossrefMedlineGoogle Scholar3. Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975;17:259-70. [PMID: 1089991] CrossrefMedlineGoogle Scholar4. Carson JL, Kelley MA, Duff A, Weg JG, Fulkerson WJ, Palevsky HI, et al. The clinical course of pulmonary embolism. N Engl J Med. 1992;326:1240-5. [PMID: 1560799] CrossrefMedlineGoogle Scholar5. Linkins LA, Choi PT, Douketis JD. Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis. Ann Intern Med. 2003;139:893-900. [PMID: 14644891] LinkGoogle Scholar6. Roy PM, Colombet I, Durieux P, Chatellier G, Sors H, Meyer G. Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ. 2005;331:259. [PMID: 16052017] CrossrefMedlineGoogle Scholar7. Roy PM, Meyer G, Vielle B, Le Gall C, Verschuren F, Carpentier F, et al. Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med. 2006;144:157-64. LinkGoogle Scholar8. Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144:165-71. LinkGoogle Scholar9. Reilly BM, Evans AT. Translating clinical research into clinical practice: impact of using prediction rules to make decisions. Ann Intern Med. 2006;144:201-9. LinkGoogle Scholar10. Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998;129:997-1005. [PMID: 9867786] LinkGoogle Scholar11. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135:98-107. [PMID: 11453709] LinkGoogle Scholar12. Wicki J, Perneger TV, Junod AF, Bounameaux H, Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med. 2001;161:92-7. [PMID: 11146703] CrossrefMedlineGoogle Scholar13. Wasson JH, Sox HC, Neff RK, Goldman L. Clinical prediction rules. Applications and methodological standards. N Engl J Med. 1985;313:793-9. [PMID: 3897864] CrossrefMedlineGoogle Scholar14. Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA. 1997;277:488-94. [PMID: 9020274] CrossrefMedlineGoogle Scholar15. Kruip MJ, Leclercq MG, van der Heul C, Prins MH, Büller HR. Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies. A systematic review. Ann Intern Med. 2003;138:941-51. [PMID: 12809450] LinkGoogle Scholar16. Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med. 2004;140:589-602. [PMID: 15096330] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Harold C. Sox, MD, EditorAffiliations: Disclosures: None disclosed.Corresponding Author: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106-1572. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAppropriateness of Diagnostic Management and Outcomes of Suspected Pulmonary Embolism Pierre-Marie Roy , Guy Meyer , Bruno Vielle , Catherine Le Gall , Franck Verschuren , Françoise Carpentier , Philippe Leveau , Alain Furber , and Prediction of Pulmonary Embolism in the Emergency Department: The Revised Geneva Score Grégoire Le Gal , Marc Righini , Pierre-Marie Roy , Olivier Sanchez , Drahomir Aujesky , Henri Bounameaux , and Arnaud Perrier Translating Clinical Research into Clinical Practice: Impact of Using Prediction Rules To Make Decisions Brendan M. Reilly and Arthur T. Evans Metrics Cited byDual processing model of medical decision-makingPulmonary embolism: predicting disease severityUncertainty in Clinical MedicineHandy Point-of-Care Decision SupportJeffrey M. Rothschild, MD, MPHWhen Is Diagnostic Testing Inappropriate or Irrational? Acceptable Regret ApproachLa clave para mejorar la clínica: más calidad con el mínimo de cantidad 7 February 2006Volume 144, Issue 3Page: 210-212KeywordsAlgorithmsAnticoagulant therapyComputersD-dimerElectronic medical recordsEmergency departmentPulmonary diseasesPulmonary embolismReasoningSafety ePublished: 7 February 2006 Issue Published: 7 February 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...