Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 49-52 , July 2009

Chest Computed Tomography in the Emergency Department for Suspected Pulmonary Embolism: It's Time to Practice What We Preach

  • Gregory Piazza, MD

      Affiliations

    • Corresponding Author InformationAddress for correspondence: Gregory Piazza, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; 857-307-1932, fax 617-307-1955
  • ,
  • Samuel Z. Goldhaber, MD

References 

  1. Piazza G, Goldhaber SZ. Acute pulmonary embolism, part I: epidemiology and diagnosis. Circulation. 2006;114:e28–e32
  2. van Belle A, Buller HR, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172–179
  3. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317–2327
  4. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med. 2001;135:98–107
  5. Kline JA, Webb WB, Jones AE, et al. Impact of a rapid rule-out protocol for pulmonary embolism on the rate of screening, missed cases, and pulmonary vascular imaging in an urban US emergency department. Ann Emerg Med. 2004;44:490–502
  6. Runyon MS, Richman PB, Kline JA. Emergency medicine practitioner knowledge and use of decision rules for the evaluation of patients with suspected pulmonary embolism: variations by practice setting and training level. Acad Emerg Med. 2007;14:53–57
  7. Kline JA, Courtney DM, Beam DM, et al. Incidence and predictors of repeated computed tomographic pulmonary angiography in emergency department patients. Ann Emerg Med. 2009;54:41–48
  8. Runyon MS, Webb WB, Jones AE, et al. Comparison of the unstructured clinician estimate of pretest probability for pulmonary embolism to the Canadian Score and the Charlotte Rule: a prospective observational study. Acad Emerg Med. 2005;12:587–593
  9. Chagnon I, Bounameaux H, Aujesky D, et al. Comparison of two clinical prediction rules and implicit assessment among patients with suspected pulmonary embolism. Am J Med. 2002;113:269–275
  10. Kabrhel C, Camargo CA, Goldhaber SZ. Clinical gestalt and the diagnosis of pulmonary embolism: does experience matter?. Chest. 2005;127:1627–1630
  11. Kabrhel C, McAfee AT, Goldhaber SZ. The contribution of the subjective component of the Canadian Pulmonary Embolism Score to the overall score in emergency department patients. Acad Emerg Med. 2005;12:915–920
  12. Kabrhel C, McAfee AT, Goldhaber SZ. The probability of pulmonary embolism is a function of the diagnoses considered most likely before testing. Acad Emerg Med. 2006;13:471–474
  13. Kabrhel C, Matts C, McNamara M, et al. A highly sensitive ELISA D-dimer increases testing but not diagnosis of pulmonary embolism. Acad Emerg Med. 2006;13:519–524
  14. Goldstein NM, Kollef MH, Ward S, et al. The impact of the introduction of a rapid D-dimer assay on the diagnostic evaluation of suspected pulmonary embolism. Arch Intern Med. 2001;161:567–571
  15. Kline JA, Mitchell AM, Kabrhel C, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2:1247–1255
  16. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6:772–780
  17. Sanchez O, Wermert D, Faisy C, et al. Clinical probability and alveolar dead space measurement for suspected pulmonary embolism in patients with an abnormal D-dimer test result. J Thromb Haemost. 2006;4:1517–1522
  18. Piazza G, Goldhaber SZ. Acute pulmonary embolism, part II: treatment and prophylaxis. Circulation. 2006;114:e42–e47
  19. Schulman S, Wahlander K, Lundstrom T, et al. Secondary prevention of venous thromboembolism with the oral direct thrombin inhibitor ximelagatran. N Engl J Med. 2003;349:1713–1721
  20. Ridker PM, Goldhaber SZ, Danielson E, et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med. 2003;348:1425–1434
  21. Kearon C, Ginsberg JS, Kovacs MJ, et al. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med. 2003;349:631–639
  22. Kearon C, Kahn SR, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:454S–545S
  23. Chertow GM. Prevention of radiocontrast nephropathy: back to basics. JAMA. 2004;291:2376–2377
  24. Daneschvar HL, Seddighzadeh A, Piazza G, et al. Deep vein thrombosis in patients with chronic kidney disease. Thromb Haemost. 2008;99:1035–1039
  25. Prandoni P, Bilora F, Marchiori A, et al. An association between atherosclerosis and venous thrombosis. N Engl J Med. 2003;348:1435–1441
  26. McCullough PA, Adam A, Becker CR, et al. Risk prediction of contrast-induced nephropathy. Am J Cardiol. 2006;98:27K–36K
  27. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284
  28. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007;298:317–323

 Supervising editor: William R. Mower, MD, PhD

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: January 21, 2009.

 Reprints not available from the authors.

PII: S0196-0644(08)02063-5

doi: 10.1016/j.annemergmed.2008.12.001

Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 49-52 , July 2009