Evaluate Pulmonary Embolism

January 12, 2021

In the last 10 years, the incidence of diagnosed pulmonary embolism (PE) has doubled, despite no change in mortality, partly due to advances in CT technology and partly due to radiologists overcalling subsegmental PEs due to medico-legal concerns. It’s important to have a rational approach to imaging for PEs, as well as a good approach to shared decision making with our colleagues, radiologists, and patients.

Review “A Rational Approach to Pulmonary Embolism Evaluation” in ACEP Now before you answer the question.

Which of the following should not be part of your approach to a patient with suspected pulmonary embolism?

Calculate the patient’s Wells’ score or PERC prior to ordering imaging.

Consider ventilation/perfusion single-photon emission CT as an alternative to CT pulmonary angiogram.

Examine clot location on imaging to help predict patient outcomes and inform shared decision making.

Start the patient on anticoagulants before discharge.