Recommendations formulated on the basis of the results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II trial have recently been published. Some of our current protocols are at variance with these.
For instance, we currently image patients with a moderate clinical probability of PE and a negative d-dimer. The PIOPED II investigators recommend that in such patients no further testing is necessary.
I won't go into all the other details, but it makes interesting reading, and we'll be reviewing our practice in consultation with the physicians.
Diagnostic Pathways in Acute Pulmonary Embolism: Recommendations of the PIOPED II Investigators.
Stein PD,Woodard PK,Weg JG,Wakefield TW,Tapson VF,Sostman HD,Sos TA,Quinn DA,Leeper KV Jr,Hull RD,Hales CA,Gottschalk A,Goodman LR,Fowler SE,Buckley JD.
Radiology. 2007 Jan;242(1):15-21.
(A similar version of this editorial was published in the December 2006 issue of the American Journal of Medicine)
Also by the same authors:
Multidetector computed tomography for acute pulmonary embolism
N Engl J Med. 2006 Jun 1;354(22):2317-27.
CONCLUSIONS: In patients with suspected pulmonary embolism, multidetector CTA-CTV has a higher diagnostic sensitivity than does CTA alone, with similar specificity. The predictive value of either CTA or CTA-CTV is high with a concordant clinical assessment, but additional testing is necessary when the clinical probability is inconsistent with the imaging results.
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