[Diagnostic management in suspicion of pulmonary embolism: results of a survey among Dutch internists and pulmonologists].
To gain insight into the incidence of suspected pulmonary embolism in the Netherlands and to evaluate the diagnostic strategy and therapeutic consequences in this patient population, a questionnaire was sent to all practising medical and pulmonary specialists (members of the respective associations). The number of patients admitted with suspected pulmonary embolism in the previous month and the diagnostic and therapeutic management in the last patient were requested. A reply was received from 698 internists and 272 pulmonologists (total response 73%). The management by the two specialist groups was not different. In the previous month 970 respondents treated 2245 patients for suspected pulmonary embolism. Extrapolated this means that 2.6 patients per 1000 inhabitants in the Netherlands are suspected of pulmonary embolism each year. Of the respondents, 95% had facilities to obtain a perfusion-ventilation scan. Of this group, 97% performed a perfusion scan when pulmonary embolism was suspected. A normal scan was found in 16% of the patients. A ventilation scan was performed in 71% of the patients with an abnormal perfusion scan result. Of all patients with an abnormal perfusion scan, 87% were treated with anticoagulants. The ventilation scan had little influence on this decision. The clinical suspicion of pulmonary embolism is a frequent clinical problem. The fact that of all patients with an abnormal perfusion scan 87% are treated, indicates overtreatment. The diagnosis of pulmonary embolism needs to be improved.
van Beek
E J
EJ
Afd. Hematologie, Academisch Medisch Centrum, Amsterdam.
Büller
H R
HR
van Royen
E A
EA
van Everdingen
J J
JJ
ten Cate
J W
JW
D000792:Angiography; D000925:Anticoagulants / Q000627:therapeutic use; D003952:Diagnostic Imaging; D006801:Humans; D007388:Internal Medicine; D009426:Netherlands; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D015272:Pulmonary Medicine; D011877:Radionuclide Imaging; D011795:Surveys and Questionnaires; D014692:Ventilation-Perfusion Ratio
D000925:Anticoagulants
Het diagnostisch beleid bij vermoeden van longembolie: resultaten van een enquête onder Nederlandse internisten en longartsen.