Evaluation of Patients With Suspected Acute Pulmonary Embolism

Publication Date: November 1, 2015
Last Updated: March 14, 2022

Best Practice Advice

Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being considered.
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Clinicians should not obtain D-dimer measurements or imaging studies in patients with a low pretest probability of PE and who meet all Pulmonary Embolism Rule-Out Criteria.
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Clinicians should obtain a high-sensitivity D-dimer measurement as the initial diagnostic test in patients who have an intermediate pretest probability of PE or in patients with low pretest probability of PE who do not meet all Pulmonary Embolism Rule-Out Criteria. Clinicians should not use imaging studies as the initial test in patients who have a low or intermediate pretest probability of PE.
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Clinicians should use age-adjusted D-dimer thresholds (age × 10 ng/mL rather than a generic 500 ng/mL) in patients older than 50 years to determine whether imaging is warranted.
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Clinicians should not obtain any imaging studies in patients with a D-dimer level below the age-adjusted cutoff.
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Clinicians should obtain imaging with CT pulmonary angiography (CTPA) in patients with high pretest probability of PE. Clinicians should reserve ventilation–perfusion scans for patients who have a contraindication to CTPA or if CTPA is not available. Clinicians should not obtain a D-dimer measurement in patients with a high pretest probability of PE.
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Recommendation Grading

Overview

Title

Evaluation of Patients With Suspected Acute Pulmonary Embolism

Authoring Organization

American College of Physicians

Publication Month/Year

November 1, 2015

Last Updated Month/Year

January 10, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This report aims to present an evidence-based and high-value diagnostic strategy for the diagnosis of PE. Its goal is to help clinicians understand the potential hurdles to such an approach and outline performance improvement strategies to overcome them.

Target Patient Population

Patients with suspected pulmonary embolism

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis

Diseases/Conditions (MeSH)

D011655 - Pulmonary Embolism, D014057 - Tomography, X-Ray Computed, D014055 - Tomography, Emission-Computed, D005338 - Fibrin Fibrinogen Degradation Products

Keywords

computed tomographic imaging (CT), Venous Thromboembolism, pulmonary embolism, embolism, d-dimer