SUSPECTED PULMONARY EMBOLISM (PE)

SUSPECTED PULMONARY EMBOLISM (PE) Calculate Clinical Probability Score Low: <= 4 PointsHigh: > 4 Points Suspected PE Negative D-Dimer Positive D-Dimer Positive CT-PE Non-Diagnostic Negative CT-PE Well's Criteria for PE Clinical Signs and Symptoms of DVT (leg swelling and pain with palpation of the deep veins) (3.0) Alternative diagnosis less likely than PE (3.0) Heart rate > 100bpm (1.5)Immobilization or surgery in last 4 weeks (1.5) Previous DVT or PE (1.5) Hemoptysis (1.0) Malignancy (ongoing or previous 6 months) (1.0) STOPTREAT Negative CT-PE Non-Diagnostic Positive CT-PESTOPTREAT Negative Leg U/S Positive Leg U/S TREAT Repeat U/S in 1 WeekDo Pulmonary Angiography Negative CT-PE Negative CT-PE OR TREAT Do Pulmonary Angiography Repeat U/S in 1 WeekWells P.S, et al. (2000). Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2003; 83: 416-20. Writing Group for the Christopher Study Investigators. (2006). Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-Dimer testing, and computer tomography. JAMA;295: 172-179.