title: Current approach to the diagnosis of acute nonmassive pulmonary embolism.
abstract: Pulmonary embolism is a common and potentially lethal disease. Given the variable presentation and associated morbidity of this condition, an accurate and efficient diagnostic algorithm is required. Clinical pretest probability serves as the root of any diagnostic approach. We, thus, review several clinical decision rules that may help standardize this determination. Using a review of the literature, the accuracy, predictive values, and likelihood ratios for several diagnostic tests are described. The combination of these tests, based on the pretest probability of disease, can be used in a Bayesian fashion to make accurate treatment decisions. A completely noninvasive diagnostic algorithm for patients presenting with suspected acute pulmonary embolism is proposed.
authors.affiliation: Department of Medicine, the Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: lmoores@usuhs.mil.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Moores
authors.affiliation: Pulmonary and Critical Care Medicine Service, William Beaumont Army Medical Center, El Paso, TX.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: King
authors.affiliation: Pulmonary, Critical Care, and Sleep Medicine Service, Walter Reed Army Medical Center, Washington, DC.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Holley
mesh_terms: D000208:Acute Disease; D015901:Angiography, Digital Subtraction; D015415:Biomarkers / Q000032:analysis; D003661:Decision Support Techniques; D004797:Enzyme-Linked Immunosorbent Assay; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014692:Ventilation-Perfusion Ratio
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D