4, 5 Diagnostic imaging for suspected PE is generally available during limited hours and only in larger centers, complicating the diagnostic approach for many patients with suspected PE. 1 - 3 Pulmonary embolism is considered in the differential diagnosis of many clinical presentations, yet fewer than 35% of patients suspected of having PE actually have PE. Pulmonary embolism (PE) is a common potentially lethal yet treatable condition. Pulmonary embolism was excluded in 34% (67/199) of the bedside test group patients with at least 2 negative results on 3 bedside tests vs 18% (35/199) excluded using only the 7-variable clinical model and the D-dimer test.Ĭonclusion Excluding PE with at least 2 negative results on 3 bedside tests safely eliminates the need for diagnostic imaging in 34% of patients with suspected PE. The follow-up venous thromboembolic event rate was 2.4% in the bedside test group vs 3.0% in the V/Q scan group ( P = .76). Results Four hundred fifty-eight consecutive adults with suspected PE were eligible for the study 398 of 399 consenting and randomized patients completed the study. The primary outcome measure was recurrent venous thromboembolic events during 3 months among patients who were not taking anticoagulant agents after the initial investigations were completed.

Further diagnostic management was determined by a blinded physician after V/Q scan. Patients assigned to the bedside test group had a sham V/Q scan performed if at least 2 of 3 bedside test results were negative otherwise, they underwent an actual V/Q scan. Methods In this double-blind, randomized, controlled equivalency trial, patients were randomized to initial bedside tests or to initial V/Q scan without bedside tests. Shared Decision Making and Communicationīackground We sought to determine whether using combinations of 3 bedside tests (7-variable clinical model, non–enzyme-linked immunosorbent assay D-dimer test, and alveolar dead-space fraction) to exclude pulmonary embolism (PE) before diagnostic imaging was as safe as a standard strategy of starting with ventilation-perfusion (V/Q) scan.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.

Clinical Implications of Basic Neuroscience.

Challenges in Clinical Electrocardiography.

Pe causing dead space ventilation