Key result
Real-world clinical PE diagnosis meets standard criteria in only ~56% of cases.
Why the study?
Clinicians do not seem to follow current recommendations when diagnosing suspected pulmonary embolism, with over-reliance on lung scans and underuse of arteriography.
Does real-world diagnostic practice for suspected pulmonary embolism align with current recommendations?
Observational (n=251)
No
Does real-world diagnostic practice for suspected pulmonary embolism align with current recommendations?
Clinicians often do not follow current recommendations for diagnosing suspected pulmonary embolism, over-relying on non-diagnostic lung scans and underusing arteriography.
Diagnostic practices for suspected PE may diverge from recommendations; leaves open optimal imaging strategies in real-world settings.
This study was carried out to examine the diagnostic approach to patients with suspected pulmonary embolism (PE) in a university hospital. A retrospective case record review of 251 patients with suspected pulmonary embolism was carried out according to a standard protocol, which looked at the utilisation of imaging techniques and compared clinical diagnoses with a standardised diagnosis established according to current recommendations. Isotopic lung scan was the most commonly used technique (73%), followed by leg vein sonography (36%) and contrast venography (31%). Lung arteriography was done in only 7% of patients. Among the 205 patients with a clinical diagnosis of PE, 115 (56%) would be diagnosed as having PE according to the standard criteria, 84 (41%) would be unclassified, and six (3%) would not be regarded as having PE. Among patients who were diagnosed as having PE and received anticoagulant therapy, 32% did not have the diagnosis confirmed by an imaging technique. Most of these had a non-diagnostic lung scan which, despite evidence to the contrary, seemed to be interpreted as confirmation of PE. We conclude that clinicians do not seem to follow current recommendations when approaching patients with suspected PE. In particular, there is an over-reliance on lung scans, and the significance of non-diagnostic scans was often misinterpreted. Arteriography was underused. These results emphasise the need to take measures to implement practice guidelines and to explore the usefulness of newer non-invasive techniques.
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Saro et al. (1999) conducted an observational in suspected pulmonary embolism (n=251). Clinical diagnosis of pulmonary embolism vs. Standardized diagnosis criteria was evaluated on Confirmation of clinical PE diagnosis by standard criteria. Clinical diagnosis of pulmonary embolism met standard diagnostic criteria in only 56% of cases, with 32% of anticoagulated patients lacking imaging confirmation.
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