Pretesting for Pulmonary Embolism

November 10, 2021

Pulmonary embolism (PE) is a frequently considered diagnosis by emergency physicians. ACEP and other medical professional societies recommend that physicians formally determine the pre-test probability for PE to stratify the need for further laboratory testing or imaging, such as computerized tomography pulmonary angiography (CTPA).

In “Electronic Pulmonary Embolism Clinical Decision Support and Effect on Yield of Computerized Tomographic Pulmonary Angiography: ePE—A Pragmatic Prospective Cohort Study,” researchers used a computerized diagnostic algorithm based on the Pulmonary Embolism Rule Out Criteria (PERC) and the Revised Geneva Score, two measures designed to assess the pre-test probability for pulmonary embolism. The algorithm recommended CTPA in patients with an age-adjusted positive D-dimer and in patients at high probability for PE.

Which of the following is not a potential advantage of employing such an approach?

A) When employed without initial risk stratification methods, pulmonary vascular imaging yields a low positive rate for PE.

B) Such an approach might reduce the number of patients undergoing unnecessary imaging tests, thus lowering radiation exposure and overall costs.

C) Without being prompted, many physicians do not reliably implement pre-test probability testing to stratify the patients who need CTPA.

D) Using a computer-based diagnostic algorithm gives better diagnostic rates compared to independent physician-initiated assessments using pre-test probability testing, such as via PERC.

None