Non-invasive diagnostic work-up patients with clinically suspected pulmonary embolism; results of a management study

M. ten Wolde*, P. J. Hagen, M. R. MacGillavry, I. J. Pollen, A. T.A. Mairuhu, M. M.W. Koopman, M. H. Prins, O. S. Hoekstra, D. P.M. Brandjes, P. E. Postmus, H. R. Büller, B. J. Sanson, J. G. Lijmer, W. de Monyé, M. V. Huisman, P. M.T. Pattynama, M. J.L. van Strijen, G. J. Kieft, F. Turkstra, R. J. RoeleveldI. J.C. Hartmann, P. F.G.M. van Waes, J. D. Banga

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Clinicians often deviate from the recommended algorithm for the diagnosis of pulmonary embolism consisting of ventilation-perfusion scintigraphy and pulmonary angiography. Objectives: To assess the safety and feasibility of a diagnostic algorithm which reduces the need for lung scintigraphy and avoids the use of angiography. Patients and methods: Consecutive patients with a clinical suspicion of pulmonary embolism were prospectively investigated according to an algorithm in which the diagnosis of pulmonary embolism was excluded after a low clinical probability estimate and a normal D-dimer test result, a normal perfusion scintigraphy result, or a non-high probability scintigraphy result in combination with normal serial ultrasonography of the legs. In these patients anticoagulant treatment was withheld and they were followed up for 3 months to record possible thromboembolic events. During the study period, 923 consecutive patients were seen, of whom 292 were excluded because of predefined criteria. Results: Of the 631 included patients, the diagnosis was refuted on the basis of a low clinical probability estimate and a normal D-dimer test result (95 patients), normal perfusion scintigraphy (161 patients) and non-high probability lung scintigraphy followed by normal serial ultrasonography (210 patients). Of these 466 patients, venous thromboembolic complications during follow-up occurred in six (complication rate 1.3%, 95% confidence interval 0.5, 2.8). The diagnostic protocol was completed in 92% of all included patients. Conclusion: The diagnosis of pulmonary embolism can be safely ruled out by a non-invasive algorithm consisting of D-dimer testing combined with a clinical probability estimate, lung scintigraphy, or serial ultrasonography of the legs (in case of non-diagnostic lung scintigraphy).

Original languageEnglish
Pages (from-to)1110-1117
Number of pages8
JournalJournal of Thrombosis and Haemostasis
Issue number7
Publication statusPublished - Jul 2004

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