Diagnostic and therapeutic strategy for acute pulmonary thromboembolism.
BACKGROUND
The diagnostic and therapeutic strategy for acute pulmonary thromboembolism (APTE) was published by the Japanese Circulation Society. But in Japan, there has been no report on how to improve the pre-test probability in APTE-suspected cases, to determine a practically available diagnostic strategy, nor has been a report that compares diagnostic methods and therapies for APTE by decision analysis.


RESULTS
APTE was found in 66.7% before using diagnostic imaging techniques. Compared with the absence of APTE, prolonged immobilization, cancer, tachycardia, unilateral leg swelling and inverted T-wave in V(1-3) were found more often in the presence of APTE. The rate of obtaining the result on the day of ordering the examination test was 100% with arterial blood gas analysis, trans-thoracic echocardiography and computed tomography (CT), 78.2% in D-dimer, 85.5% in pulmonary angiography, and 54.5% in perfusion lung scan. Decision analysis showed that the highest expected utility was anticoagulant over 0.51 in pre-test probability, with CT between 0.13 and 0.51.


CONCLUSIONS
The pre-test probability of APTE has already been high before using specific diagnostic imaging techniques in Japan. Our results showed that the diagnostic strategy for APTE made by the Japanese Circulation Society was available in most hospitals in Japan.
Sakuma
Masahito
M
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryomachi, Sendai.
Nakamura
Mashio
M
Nakanishi
Norifumi
N
Miyahara
Yoshiyuki
Y
Tanabe
Nobuhiro
N
Yamada
Norikazu
N
Fukui
Shigefumi
S
Wang
Huan
H
Kuriyama
Takayuki
T
Kunieda
Takeyoshi
T
Sugimoto
Tsuneaki
T
Nakano
Takeshi
T
Shirato
Kunio
K
D000208:Acute Disease; D003663:Decision Trees; D006801:Humans; D007564:Japan; D017410:Practice Guidelines as Topic; D011336:Probability; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed