Management of suspected pulmonary embolism patients with low clinical and low V/Q probability.
OBJECTIVE
To assess whether guidelines for the management of suspected PE, recommending that ventilation/perfusion (V/Q) scintigraphy should be followed by other imaging in case of non-diagnostic result, and interpreted along with the clinical probability, are applied in daily practice.


METHODS
Two-year audit study.


METHODS
Tertiary hospital in France.


METHODS
All patients referred to the nuclear medicine department for a suspected pulmonary embolism (PE), with a low clinical probability, a positive D-Dimer test, and a low V/Q scintigraphy.


METHODS
We reviewed medical records to collect data on further diagnostic strategy and therapeutic management.


METHODS
Thromboembolic risk during a three-month follow up in patients who did not undergo anticoagulation therapy on the basis of a negative diagnostic work up.


RESULTS
Of the 456 selected patients, PE was excluded on the basis of a low pretest probability and a low V/Q scintigraphy probability without further testing in 184 (group 1). In the other 272 patients (group 2), 4 venous thromboembolism (VTE) events were diagnosed by leg vein ultrasonography and/or computed tomography pulmonary angiography. In patients who did not receive anticoagulant treatment during follow up, one patient from group 1 (0.6%, 95% confidence interval 0.1 to 3.3) and two patients from group 2 (0.9%, 95% CI 0.2 to 3.2) had an acute venous thromboembolic event.


CONCLUSIONS
Different attitudes are adopted by physicians in patients with a low clinical probability and a low V/Q scintigraphy probability, without impact on safety, as assessed by a non-significant difference in the three-month thromboembolic risks between these two groups.
Salaun
Pierre-Yves
PY
Département de Médecine Interne et de Pneumologie, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest Cedex, France.
Le Duc-Pennec
Alexandra
A
Le Gal
Grégoire
G
Couturaud
Francis
F
Guillo
Philippe
P
Mottier
Dominique
D
Bizais
Yves
Y
Leroyer
Christophe
C
D000465:Algorithms; D000792:Angiography / Q000379:methods; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D010477:Perfusion; D011336:Probability; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging / Q000379:methods*; D012306:Risk; D013923:Thromboembolism / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods; D014692:Ventilation-Perfusion Ratio
D000925:Anticoagulants