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Suspected Pulmonary Embolism Appropriate Use Criteria

UC Suspected Pulmonary Embolism AUC (pdf)

Priority Clinical Area Coverage

 This AUC reasonably addresses the entire clinical scope of the "Suspected pulmonary embolism" Priority Clinical Area (PCA) and is considered relevant to that PCA.

Search Strategy and Sources – Completed 2023-04-24

  • Limits:  English, 15 years publication, and adult, 19+
  • Extensive PubMed (Medline), Supplemental: EMBase, Web of Science, and Cochrane Database of Systematic Reviews.

( (pulomonary embolism AND diagnostic imaging(major) AND investigative technique(major) )  OR
(pulmonary embolism AND diagnostic imaging AND investigative technique AND review/document type))

OR
(  ( (PE AND diagnostic imaging OR PE/diagnostic imaging (major) )
AND ( (practice guidelines as topic OR decision support techniques OR sensitivity and specificity
OR predictive value of tests OR evidence based medicine) ) )

Results

94 publications were examined by team leaders. 30 references were determined to be relevant and distributed to the team for grading. The result are 10 references for the AUC.

Suspected Pulmonary Embolism AUC References and OCEBM Level of Evidence

On evaluation of the pregnant patient:

  1. Duran-Mendicuti, A. and A. Sodickson (2011). "Imaging evaluation of the pregnant patient with suspected pulmonary embolism." Int J Obstet Anesth20(1): 51-59. Leve 3
  2. Abele, Jonathan T., and Parveen Sunner. “The Clinical Utility of a Diagnostic Imaging Algorithm Incorporating Low-Dose Perfusion Scans in the Evaluation of Pregnant Patients With Clinically Suspected Pulmonary Embolism.” Clinical Nuclear Medicine, vol. 38, no. 1, 2013, pp. 29–32. Level 3
  3. “American College of Radiology ACR Appropriateness Criteria® Suspected Pulmonary Embolism .” ACR Appropriateness Criteria, American College of Radiology, 2016, acsearch.acr.org/docs/69404/Narrative/.
  4. van der Pol, L.M., et al., Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med, 2019. 380(12): p. 1139-1149. Level 2

On the use of D-dimer:

5. Hoo, G. W., et al. (2011). "Does a clinical decision rule using D-dimer level improve the yield of pulmonary CT angiography?" AJR Am J Roentgenol196(5): 1059-1064. Level 3

6. Galipienzo, J., et al., Effectiveness of a diagnostic algorithm combining clinical probability, D-dimer testing, and computed tomography in patients with suspected pulmonary embolism in an emergency department. Rom J Intern Med, 2012, 50(3):p.195-202. Level 3


On Pre-Test Risk Stratification with PERC and Wells:

7.  Freund, Yonathan, et al. “Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients.” Jama, vol. 319, no. 6, 2018, p. 559., doi:10.1001/jama.2017.21904.   Level 4

8.  Gibson, N.S, et al. “Further Validation and Simplification of the Wells Clinical Decision Rule in Pulmonary Embolism.” Thrombosis and Haemostasis, vol. 99, no. 01, 2008, pp. 229–234., doi:10.1160/th07-05-0321. Level 3

9.  Singh, Balwinder, et al. “Pulmonary Embolism Rule-out Criteria (PERC) in Pulmonary Embolism—Revisited: A Systematic Review and Meta-Analysis.” Emergency Medicine Journal, vol. 30, no. 9, 2012, pp. 701–706., doi:10.1136/emermed-2012-201730. Level 1

On Gestalt as a Risk Stratification Method: 

10.  Kline, Jeffrey A., and William B. Stubblefield. “Clinician Gestalt Estimate of Pretest Probability for Acute Coronary Syndrome and Pulmonary Embolism in Patients With Chest Pain and Dyspnea.” Annals of Emergency Medicine, vol. 63, no. 3, 2014, pp. 275–280., doi:10.1016/j.annemergmed.2013.08.023. Level 2

11.  Raja, Ali S., et al. “Effect of Computerized Clinical Decision Support on the Use and Yield of CT Pulmonary Angiography in the Emergency Department.” Radiology, vol. 262, no. 2, 2012, pp. 468–474., doi:10.1148/radiol.11110951. Level 3