Received 22 January 1999; received in revised form 11 May 1999 and 26 July 1999; accepted 7 September 1999.
Abstract
In 1990, the multicenter Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED), sponsored by the National Institutes of Health, compared the diagnostic value of the radioisotopic ventilation-perfusion lung scan (V/Q scan) with that of pulmonary angiography for the diagnosis of pulmonary embolism (PE). Despite the endurance of the radioisotopic V/Q scan as the most widely used test for evaluation of pulmonary embolism (PE), a better screening tool is clearly needed for use in the emergency department. During the past decade, several new modalities have emerged for evaluation of patients with suspected PE. We evaluate the diagnostic utility of the D -dimer test and the alveolar dead space determination as potential screening tests and of spiral computed tomography, magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography as potential confirmatory tests for PE. For comparison, recent data on the diagnostic utility of the alveolar-arterial oxygen gradient and the V/Q scan are included. The potential application of these new tests to a hypothetical ED population is described. [Kline JA, Johns KL, Colucciello SA, Israel EG. New diagnostic tests for pulmonary embolism. Ann Emerg Med. February 2000;35:168-180.]
*Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
‡Department of Emergency Medicine, Eastern Virginia School of Medicine, Norfolk, VA
§Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO.
☆None of the authors have received funds from any private or public source for the explicit purpose of writing this article.
☆☆Two of the authors (JAK, EGI) are engaged in a multicenter trial involving the use of dead space and SimpliREDD-dimer measurements to screen for pulmonary embolism, the Rapid Exclusion of Pulmonary Embolism (REPE) study. The authors’ institutions receive a $100 stipend for each patient enrolled in the REPE study.
★ Address for reprints: Jeffrey Kline, MD, Department of Emergency Medicine, MEB 304, Carolinas Medical Center, Charlotte, NC 28232-2861; 704-355-7092, fax 704-355-7047; E-mail Jkline@carolinas.org.
ABSTRACT