Usefulness of Clinical Pre-test Scores for a Correct Diagnostic Pathway in Patients with Suspected Pulmonary Embolism in Emergency Room

Background: Pulmonary Embolism (PE) is a disease characterized by not specific signs and symptoms. In Italy, there are about 65,000 cases per year; mortality is about 30% if PE is not identified and decreases to 2-8% if PE is recognized and treated. International guidelines include several strategies for diagnosing the disease with confidence. The diagnostic pathway includes a clinical approach with the Wells and Revised Geneva scores, the use of D-dimer and, eventually, a Computed Tomography (CT). The CT seems to be the ideal investigation to confirm or exclude PE but it is not free from complications. Sometimes in medical practice clinicians tend to order CT more frequently than necessary, reflecting a defensive behavior instead of an evidence based behavior. This practice exposes patients to some risks, especially for kidney.