title: Methodology for a rapid protocol to rule out pulmonary embolism in the emergency department.
abstract: We propose an emergency department (ED) pulmonary embolism rule-out protocol based on pretest probability assessment coupled with either a negative D -dimer assay result or a negative D -dimer assay result plus a normal alveolar dead-space measurement. We examine the safety, efficiency, and feasibility of such a protocol, paying special attention to implicit and explicit strategies of pretest probability assessment among patients with suspected pulmonary embolism. Finally, we assess the potential effect of the proposed pulmonary embolism rule-out protocol on use of imaging resources and ED throughput.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28203, USA. Jkline@carolina.rr.com
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
mesh_terms: D000465:Algorithms; D002985:Clinical Protocols / Q000592:standards; D003663:Decision Trees; D003937:Diagnosis, Differential; D004526:Efficiency; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D004797:Enzyme-Linked Immunosorbent Assay / Q000592:standards; D004903:Erythrocyte Aggregation; D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D007118:Immunoassay / Q000592:standards; D007841:Latex Fixation Tests / Q000592:standards; D007902:Length of Stay; D019095:Point-of-Care Systems / Q000592:standards; D011650:Pulmonary Alveoli; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D012126:Respiratory Dead Space; D018570:Risk Assessment; D012307:Risk Factors; D012449:Safety; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D