Acute pulmonary embolism: appropriateness of emergency department management according to clinical guidelines

Abstract

Background and aims: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism.

Materials and methods: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively.

Results: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard D-dimer or age-adjusted D-dimer was used.

Conclusions: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.

Keywords: Adherence to clinical guidelines; Adherencia a guías de práctica clínica; Angiografía por tomografía computarizada; Clinical decision rules; Computed tomography angiography; D-dimer; Dímero D; Embolia pulmonar; Predictive value of tests; Pulmonary embolism; Reglas de decisión clínica; Valor predictivo de las pruebas.