Advances and challenges in the emergency diagnosis of pulmonary embolism

Over recent years, the rising number of diagnosed events without a reduction in overall mortality - even as case fatality from pulmonary embolism has decreased - suggests overdiagnosis, driven by detection of smaller or clinically marginal emboli. This supports probability-based testing: anchor decisions in pretest probability, apply thresholds adjusted to the pre-test probability, and reserve imaging for patients likely to benefit. The aim is to balance safety, diagnostic yield, and exposure to radiation and iodinated contrast while preserving overall quality of care.