Active implementation of a consensus strategy improves diagnosis and management in suspected pulmonary embolism

Our consensus-based strategy in the diagnostic management of patients with pulmonary embolism involves a perfusion lung scan, a ventilation lung scan, compression ultrasonography and pulmonary angiography, in sequence. We com pared the diagnostic approach in patients with clinically suspected pulmona ry embolism before the active implementation of this strategy (retrospectiv e analysis of 618 patients, April 1992-March 1995) and after (prospective s tudy of 250 patients, April 1995-March 1996), with another assessment 1 yea r later. The measured outcomes were: (i) final diagnosis of pulmonary embol ism either directly by pulmonary angiography, indirectly by compression ult rasonography of the leg veins, or with a high probability from a ventilatio n/perfusion lung scan; (ii) prescription of anticoagulant therapy. Before s trategy implementation, pulmonary embolism was adequately confirmed or excl uded in 11% of patients with an abnormal perfusion lung scan; in 55% the di agnosis remained uncertain, but the patient received anticoagulants. After implementation, these figures were 58.5% and 13%, respectively. A modest fu rther improvement was observed 1 year later. Active implementation of a con sensus-based strategy in the diagnosis of pulmonary embolism increases defi nite diagnoses, and reduces the numbers treated with anticoagulants. It ind uces a rapid change in the diagnostic behaviour of physicians.