title: Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected pulmonary embolism.
abstract: This clinical policy from the American College of Emergency Physicians is the revision of a 2003 clinical policy on the evaluation and management of adult patients presenting with suspected pulmonary embolism (PE).(1) A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Do objective criteria provide improved risk stratification over gestalt clinical assessment in the evaluation of patients with possible PE? (2) What is the utility of the Pulmonary Embolism Rule-out Criteria (PERC) in the evaluation of patients with suspected PE? (3)What is the role of quantitative D-dimer testing in the exclusion of PE? (4) What is the role of computed tomography pulmonary angiogram of the chest as the sole diagnostic test in the exclusion of PE? (5) What is the role of venous imaging in the evaluation of patients with suspected PE? (6) What are the indications for thrombolytic therapy in patients with PE? Evidence was graded and recommendations were given based on the strength of the available data in the medical literature.
authors.forename: Francis M
authors.initials: FM
authors.lastname: Fesmire
authors.forename: Michael D
authors.initials: MD
authors.lastname: Brown
authors.forename: James A
authors.initials: JA
authors.lastname: Espinosa
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shih
authors.forename: Scott M
authors.initials: SM
authors.lastname: Silvers
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wolf
authors.forename: Wyatt W
authors.initials: WW
authors.lastname: Decker
mesh_terms: D000367:Age Factors; D000368:Aged; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy; D012307:Risk Factors; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D