The diagnosis and treatment of pulmonary embolism engage the internist as few other diseases do, for many good reasons. Physicians often miss the diagnosis (1). The mortality rate for untreated pulmonary embolism is quite high (2, 3) and is much lower when the disorder is correctly treated (4). However, treatment-related bleeding carries a substantial fatality rate (5). Pulmonary angiography, still the definitive test, is inconvenient to do at night, and the sensitivity of noninvasive imaging tests is still too low to rule out disease when clinical suspicion is high (6).

The medical literature contains 2 lines of inquiry regarding the ...

References

  • 1. Uhland IIGoldberg LMPulmonary embolism: a commonly missed clinical entity. Dis Chest1964;45:533-6. [PMID: 14147480] CrossrefMedlineGoogle Scholar
  • 2. Barritt DWJordan SCAnticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. Lancet1960;1:1309-12. [PMID: 13797091] CrossrefMedlineGoogle Scholar
  • 3. Dalen JEAlpert JSNatural history of pulmonary embolism. Prog Cardiovasc Dis1975;17:259-70. [PMID: 1089991] CrossrefMedlineGoogle Scholar
  • 4. Carson JLKelley MADuff AWeg JGFulkerson WJPalevsky HIet alThe clinical course of pulmonary embolism. N Engl J Med1992;326:1240-5. [PMID: 1560799] CrossrefMedlineGoogle Scholar
  • 5. Linkins LAChoi PTDouketis JDClinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis. Ann Intern Med2003;139:893-900. [PMID: 14644891] LinkGoogle Scholar
  • 6. Roy PMColombet IDurieux PChatellier GSors HMeyer GSystematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ2005;331:259. [PMID: 16052017] CrossrefMedlineGoogle Scholar
  • 7. Roy PMMeyer GVielle BLe Gall CVerschuren FCarpentier Fet alAppropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med2006;144:157-64. LinkGoogle Scholar
  • 8. Le Gal GRighini MRoy PMSanchez OAujesky DBounameaux Het alPrediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med2006;144:165-71. LinkGoogle Scholar
  • 9. Reilly BMEvans ATTranslating clinical research into clinical practice: impact of using prediction rules to make decisions. Ann Intern Med2006;144:201-9. LinkGoogle Scholar
  • 10. Wells PSGinsberg JSAnderson DRKearon CGent MTurpie AGet alUse of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med1998;129:997-1005. [PMID: 9867786] LinkGoogle Scholar
  • 11. Wells PSAnderson DRRodger MStiell IDreyer JFBarnes Det alExcluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med2001;135:98-107. [PMID: 11453709] LinkGoogle Scholar
  • 12. Wicki JPerneger TVJunod AFBounameaux HPerrier AAssessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med2001;161:92-7. [PMID: 11146703] CrossrefMedlineGoogle Scholar
  • 13. Wasson JHSox HCNeff RKGoldman LClinical prediction rules. Applications and methodological standards. N Engl J Med1985;313:793-9. [PMID: 3897864] CrossrefMedlineGoogle Scholar
  • 14. Laupacis ASekar NStiell IGClinical prediction rules. A review and suggested modifications of methodological standards. JAMA1997;277:488-94. [PMID: 9020274] CrossrefMedlineGoogle Scholar
  • 15. Kruip MJLeclercq MGvan der Heul CPrins MHBüller HRDiagnostic strategies for excluding pulmonary embolism in clinical outcome studies. A systematic review. Ann Intern Med2003;138:941-51. [PMID: 12809450] LinkGoogle Scholar
  • 16. Stein PDHull RDPatel KCOlson REGhali WABrant Ret alD-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med2004;140:589-602. [PMID: 15096330] LinkGoogle Scholar