In the June 2011 issue of the Annals of Emergency Medicine, the American College of Emergency Physicians published a clinical policy focusing on critical issues in the emergency department evaluation and management of adult patients presenting with suspected pulmonary embolism (PE). This is a revision of a clinical policy on suspected PE that was published in 2003.

This clinical policy can also be found on ACEP’s website (www.acep.org) and will be submitted for abstraction on the National Guideline Clearinghouse website (www.guidelines.gov).

This clinical policy takes an evidence-based approach to answering six frequently encountered questions related to emergency department decision making. Recommendations (Level A, B, or C) for patient management are provided based on the strength of evidence using the Clinical Policies Committee’s well-established methodology: Level A recommendations represent patient management principles that reflect a high degree of clinical certainty; Level B recommendations represent patient management principles that reflect moderate clinical certainty; Level C recommendations represent other patient management strategies based on Class III studies, or in the absence of any adequate published literature, based on consensus of the members of the Clinical Policies Committee.

During development, this clinical policy was reviewed and expert review comments were received from individual physicians in the fields of emergency medicine and cardiology, and from individual members of the American College of Chest Physicians, the American College of Radiology, ACEP’s Emergency Ultrasound Section, and ACEP’s Quality and Performance Committee. Their responses were used to refine and enhance this policy further; however, their responses did not imply endorsement of this clinical policy.

It is estimated that 650,000 to 900,000 individuals have pulmonary embolism each year in the United States, resulting in approximately 200,000 deaths. Furthermore, survivors of pulmonary embolism can experience disabling morbidity from pulmonary hypertension or postthrombotic syndrome. Since publication of the 2003 ACEP clinical policy on pulmonary embolism, there have been more than 1,000 publications each year on the subject of pulmonary embolism. The 2011 policy focuses on six critical questions of interest and/or controversy that have developed or still exist since the formulation of the 2003 policy. Due to the strong association between deep vein thrombosis (DVT) and pulmonary embolism, commonly known as venous thromboembolism (VTE) disease, it is difficult to discuss one without the other. For this reason, ACEP has decided to focus on pulmonary embolism and not update the 2003 ACEP policy on deep vein thrombosis.