Cardiology

ACP Releases Best Practices for Evaluating Suspected Pulmonary Embolism

The American College of Physicians has issued new guidelines for the evaluation of patients with suspected acute pulmonary embolism (PE).

These guidelines come in response to rising rates of tests for suspected acute PE, and the potential harm associated with overuse of specific tests, including computed tomography and plasma D-dimer. 
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The ACP notes that, rather than being based on a formal systematic review, these guidelines are instead designed to “provide practical advice based on the best available evidence and recent guidelines.”

This “Best Practice Advice” includes:

  • Use validated clinical prediction rules to estimate pretest probability in patients with suspected acute PE.
  • Do not conduct imaging studies in patients with low pretest probability.
  • Obtain a high-sensitivity D-dimer measurement as the initial diagnostic test in patients with intermediate pretest probability of PE.
  • Use age-adjusted D-dimer thresholds rather than generic measurements in patients older than 50 years.
  • Do not conduct imagine studies with patients with D-dimer level below age-adjusted cutoffs.
  • Conduct a CT pulmonary angiography in patients with high pretest probability of PE.

“The first step when evaluating a patient with suspected acute PE is to establish his or her pretest probability of PE,” they concluded.

“The Pulmonary Embolism Rule-Out Criteria were specifically developed to help guide clinicians in identifying patients with low pretest probabilities of PE in whom the risks of any testing outweigh the risk for PE.”

—Michael Potts

Reference:

Raja AS, Greenberg JO, Qaseem A, et al. Evaluation of patients with suspected acute pulmonary embolism: best practice advice from the clinical guidelines committee of the American College Of Physicians. Ann Intern Med. September 29, 2015 [epub ahead of print]. doi:10.7326/M14-1772