PE Clinical Probability

Determine pretest probability of PE to guide workup

Questions

1.DVT symptoms: Leg swelling and pain with palpation in the deep-vein region?
2.PE is as likely or more likely than an alternative diagnosis?
3.Immobilization: Bedrest ≥3 days or surgery in last 4 weeks?
4.Previous DVT/PE?
5.Hemoptysis?
6.Malignancy: Cancer treatment currently or in last 6 months (or receiving palliative care)?
7.Heart rate?

About

The diagnostic accuracy for PE improves when the clinical probability is estimated before the use diagnostic tests. It is important to note that, when using the scoring system by itself, PE cannot be ruled out completely in patients with a low probability score or confirmed in patients with a high probability score. However, use of such a score can help inform interpretation of subsequent diagnostic tests and reduce the need for invasive testing. For instance, in one study, the combination of a low clinical probability and a negative d-dimer result was able to exclude PE without further diagnostic imaging. Because multiple D-dimer assays are available, physicians should ensure that a proven high-sensitivity assay is available and that the test has been validated/audited in their institution.

References

Chunilal SD, et al.

Does this patient have pulmonary embolism?

JAMA: the Journal of the American Medical Association 2003 December 3, 290 (21): 2849-58

The PE Clinical Probability calculator is created by QxMD.

Created by on 12/06/2016

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1. DVT symptoms: Leg swelling and pain with palpation in the deep-vein region?

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