Annals of Emergency Medicine
Volume 55, Issue 4 , Pages 307-315.e1 , April 2010

Clinical Features From the History and Physical Examination That Predict the Presence or Absence of Pulmonary Embolism in Symptomatic Emergency Department Patients: Results of a Prospective, Multicenter Study

Presented at the Society for Academic Emergency Medicine annual meeting, May 31, 2008, Washington, DC.

  • D. Mark Courtney, MD

      Affiliations

    • Department of Emergency Medicine, Northwestern University, Chicago, IL
    • ,
  • Jeffrey A. Kline, MD

      Affiliations

    • Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
    • Corresponding Author InformationAddress for correspondence: Jeffrey A. Kline, MD, Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard. Charlotte NC, 28203; 704-355-3658, Fax 704-355-7047
    • ,
  • Christopher Kabrhel, MD, MPH

      Affiliations

    • Department of Emergency Services, Massachusetts General Hospital, Boston, MA
    • ,
  • Christopher L. Moore, MD

      Affiliations

    • Department of Emergency Medicine, Yale University Medical Center, New Haven, CT
    • ,
  • Howard A. Smithline, MD

      Affiliations

    • Department of Emergency Medicine, Baystate Medical Center, Springfield MA
    • ,
  • Kristen E. Nordenholz, MD

      Affiliations

    • Department of Surgery, Division of Emergency Medicine, University of Colorado School of Health Sciences, Denver, CO
    • ,
  • Peter B. Richman, MD, MBA

      Affiliations

    • Department of Emergency Medicine, Mayo Clinic Arizona, Scottsdale, AZ
    • ,
  • Michael C. Plewa, MD

      Affiliations

    • Department of Emergency Medicine, St. Vincent Mercy Medical Center, Toledo, OH

Received 4 August 2009 ,Revised 31 October 2009 ,Accepted 6 November 2009.

References 

  1. McCaig LF, Nawar EW. National hospital ambulatory care survey: 2004 emergency department summary. Adv Data. 2006;372:1–29
  2. Kabrhel C, Matts C, McNamara C, et al. A highly sensitive ELISA D-dimer increases testing but not diagnosis of pulmonary embolism. Acad Emerg Med. 2006;13:519–524
  3. 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
  4. Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients' probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000;83:416–420
  5. Wicki J, Perneger TV, Junod AF, et al. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med. 2001;161:92–97
  6. Kline JA, Nelson RD, Jackson RE, et al. Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study. Ann Emerg Med. 2002;39:144–152
  7. 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
  8. LeGal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144:165–171
  9. Runyon MS, Richman PB, Kline JA, et al. 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
  10. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6:772–780
  11. 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
  12. Kline JA, Johnson CL, Webb WB, et al. Prospective study of clinician-entered research data in the emergency department using an internet-based system after the HIPPA privacy rule. BMC Med Inform Decis Mak. 2004;4:17
  13. Kline JA, Mitchell AM, Runyon MS, et al. Electronic medical record review as a surrogate to telephone follow-up to establish outcome for diagnostic research studies in the emergency department. Acad Emerg Med. 2005;12:1127–1133
  14. Anderson DR, Kahn SR, Rodger MA, et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA. 2007;298:2743–2753
  15. Perrier A, Roy PM, Aujesky D, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. 2004;116:291–299
  16. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317–2327
  17. Righini M, Le Gal G, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomized non-inferiority trial. Lancet. 2008;371:1343–1352
  18. Tsai AW, Cushman M, Rosamond WD, et al. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med. 2002;162:1182–1189
  19. Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year-population-based study. Arch Intern Med. 1998;158:585–593
  20. Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160:809–815
  21. Blom JW, Doggen CJ, Osanto S, et al. Malignancies, prothrombic mutations, and the risk of venous thrombosis. JAMA. 2005;293:715–722

 Supervising editor: Steven M. Green, MD

 Author contributions: DMC and JAK participated in the conception and organization of the study. DMC, JAK, CK, CLM, HAS, KEN, PBR, and MCP participated in data collection and analysis and drafting and revising the article. DMC, JAK, CK, CLM, HAS, PBR, and MCP obtained funding. DMC, CK, CLM, HAS, PBR, and MCP participated in the writing of the study protocol. JAK had access to all the data in the study. DMC takes responsibility for the paper as a whole.

 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. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. National Institutes of Health grants 5K23HL077404(01-05) and 1K23HL077404-01 (Dr. Courtney) and 2R42HL074415-02A1, 5R42HL074415-03, R41HL074415, R42HL074415, and R01HL074384 (Dr. Kline).

 Publication date: Available online January 1, 2010.

 Reprints not available from the authors.

 Please see page 308 for the Editor's Capsule Summary of this article.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

PII: S0196-0644(09)01735-1

doi: 10.1016/j.annemergmed.2009.11.010

Annals of Emergency Medicine
Volume 55, Issue 4 , Pages 307-315.e1 , April 2010

Article Tools

* Image Usage & Resolution