Annals of Emergency Medicine
Volume 55, Issue 4 , Pages 327-330 , April 2010

Further Illumination of the Test Threshold Approach in the Care of Emergency Department Patients With Symptoms of Pulmonary Embolism

  • Jeffrey A. Kline, MD

      Affiliations

    • Corresponding Author InformationAddress for correspondence: Jeffrey A. Kline, MD, Emergency Medicine Research, Department of Emergency Medicine, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28323-2861; 704-355-7092, fax 704-355-7047

References 

  1. Lessler Al, Isserman JA, Agarwal , et al. Testing low-risk patients for suspected pulmonary embolism: a decision analysis. Ann Emerg Med. 2010;55:316–326
  2. Pauker SG, Kassirer JP. The threshold approach to clinical decision making. N Engl J Med. 1980;302:1109–1117
  3. 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
  4. Kline JA. Diagnosing pulmonary embolism in the emergency department: maybe we do matter, after all. Emerg Med Australas. 2009;21:247–249
  5. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386–1389
  6. Laporte S, Mismetti P, Decousus H, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation. 2008;117:1711–1716
  7. Kline JA, Heistand B, Schreiber DH, et al. Infrequent use of empiric anticoagulation for severe pulmonary embolism [abstract]. Acad Emerg Med. 2009;16:34
  8. Mitchell AM, Jones AE, Tumlin JA, et al. Incidence of contrast-induced nephropathy after contrast-enhanced computed tomography in the outpatient setting. Clin J Am Soc Nephrol. 2010;5:4–9
  9. Kooiman J, Klok FA, Mos IC, et al. Incidence and predictors of contrast-induced nephropathy following CT-angiography for clinically suspected acute pulmonary embolism. J Thromb Haemost. In press.
  10. Mitchell AM, Kline JA. Contrast nephropathy following computed tomography angiography of the chest for pulmonary embolism in the emergency department. J Thromb Haemost. 2007;5:50–54
  11. Courtney DM, Miller CD, Smithline HA, et al. Prospective multi-center assessment of interobserver agreement for radiologist interpretation of multidetector CT angiography for pulmonary embolism. J Thromb Haemost. In press.
  12. 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
  13. Thornworth W. CPT(R) Assistant. Chicago, IL: American Medical Association; 2009;

 Supervising editor: Steven M. Green, MD

 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. Dr. Kline owns stock in BreathQuant Medical, LLC, which manufactures a breath device designed to diagnose and monitor for pulmonary embolism.

 Publication date: Available online February 1, 2010.

 Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com.

 Reprints not available from the author.

PII: S0196-0644(10)00026-0

doi: 10.1016/j.annemergmed.2010.01.005

Annals of Emergency Medicine
Volume 55, Issue 4 , Pages 327-330 , April 2010

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