title: Diagnostic approach to pulmonary embolism in a rural emergency department.
abstract: BACKGROUND
  Pulmonary embolism (PE) is a serious condition with mortality estimates of up to 10%. We sought to investigate the diagnosis of PE, time to access imaging and diagnostic utility of each modality in a rural emergency department (Ed).
  
  
  METHODS
  We completed a retrospective chart review to determine the investigations performed and treatments initiated in the management of suspected PE in a rural hospital.
  
  
  RESULTS
  A total of 47 charts from a 5-year period were reviewed. Of these, 83.0% indicated a D-dimer test was ordered, and 31.9% and 40.4% indicated either ventilation-perfusion (V/Q) or computed tomography (CT) were ordered during the ED visit. Computed tomography diagnosed 11 of the 12 instances of confirmed PE. Mean time to patients undergoing V/Q or CT was 1.58 and 1.59 days, respectively. Low-molecular-weight heparin was started in 83.0% of patients.
  
  
  CONCLUSIONS
  In this ED there may be over reliance on the D-dimer test, irrespective of Wells score. Access to V/Q and CT were similar to that of an urban centre. Empiric anticoagulation was started in most patients.
authors.affiliation: Department of Emergency Medicine, University of Western Ontario and South Huron Hospital Association, Exeter, Ontario. mikeballantine@gmail.com
authors.forename: Mike
authors.initials: M
authors.lastname: Ballantine
authors.forename: Munsif
authors.initials: M
authors.lastname: Bhimani
authors.forename: W Ken
authors.initials: WK
authors.lastname: Milne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006495:Heparin, Low-Molecular-Weight / Q000032:analysis; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012123:Pulmonary Ventilation; D011859:Radiography; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012424:Rural Population; D012680:Sensitivity and Specificity; D013223:Statistics as Topic / Q000379:methods; D015898:Tomography Scanners, X-Ray Computed; D018608:Ultrasonography, Doppler
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D006495:Heparin, Low-Molecular-Weight; C036309:fibrin fragment D