Diagnostic approach to patients with suspected pulmonary embolism: a report from the real world

This study was carried out to examine the diagnostic approach to patients w ith suspected pulmonary embolism (PE) in a university hospital. A retrospec tive case record review of 251 patients with suspected pulmonary embolism w as carried out according to a standard protocol, which looked at the utilis ation of imaging techniques and compared clinical diagnoses with a standard ised diagnosis established according to current recommendations. Isotopic l ung scan was the most commonly used technique (73%), followed by leg vein s onography (36%) and contrast venography (31%). Lung arteriography was done in only 7% of patients, Among the 205 patients with a clinical diagnosis of PE, 115 (56%) would be diagnosed as having PE according to the standard cr iteria, 84 (41%) would be unclassified, and six (3%) would not be regarded as having PE. Among patients who were diagnosed as having PE and received a nticoagulant therapy, 32% did not have the diagnosis confirmed by an imagin g technique, Most of these had a non-diagnostic lung scan which, despite ev idence to the contrary, seemed to be interpreted as confirmation of PE. We conclude that clinicians do not seem to follow current recommendations when approaching patients with suspected PE. In particular, there is an over-re liance on lung scans, and the significance of non-diagnostic scans was ofte n misinterpreted. Arteriography was underused. These results emphasise the need to take measures to implement practice guidelines and to explore the u sefulness of newer non-invasive techniques.