Kruip et al reported a simple diagnostic strategy for the diagnosis of pulmonary embolism in a hospitalized patient. The authors are from Erasmus University Medical Center, Academic Medical Center Amsterdam, University Medical Centre Leiden, Rijnstate Hospital Arnhem, Meander Medical Center Amersfoort and the University of Maastricht.
Patient selection: hospitalized patient with a suspected pulmonary embolism
Parameters:
(1) simple clinical model of Wells et al, from 0 to 12.5
(2) D-dimer test (normal if <= 500 ng/mL fibrinogen equivalents)
(3) CT scan in selected patients
If the simple clinical score is <= 4 and if the D-dimer is normal, then a pulmonary embolism is unlikely and no CT scan is performed.
If the simple clinical rule is > 4 OR if the D-dimer is abnormal, then a helical CT scan is performed.
If the CT scan is positive, then the patient is treated for pulmonary embolism.
If the CT scan is negative, then a pulmonary embolism is considered excluded and no treatment is given.
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