Pulmonary embolism

The management of suspected pulmonary embolism is a subject in which consensus has been difficult to achieve due to the lack of firm evidence.1 Against this background, the British Thoracic Society has suggested a “practical approach to suspected acute pulmonary embolism.”2 After a comprehensive review of current literature, the report makes several recommendations, graded for evidence, and finishes with a series of charts designed for a junior doctor's handbook covering diagnosis and management. While some of the recommendations lack top grade evidence and inevitably will be controversial, the authors achieve what they set out to do and provide a practical approach to a difficult subject using new knowledge “little of which,” as the report bluntly states, “has filtered through to clinical practice.” Certain items in this comprehensive report are worth emphasising. Pulmonary embolism is both underdiagnosed and overdiagnosed. Ten per cent of all hospital deaths are due to acute pulmonary embolism, most of which are diagnosed only at necroscopy. It is easily missed in patients with cardiorespiratory disease (in whom even small emboli can be fatal), elderly patients, and those …