title: Probability scores and diagnostic algorithms in pulmonary embolism: are they followed in clinical practice?
abstract: BACKGROUND
  Clinical probability scores (CPS) determine the pre-test probability of pulmonary embolism (PE) and assess the need for the tests required in these patients. Our objective is to investigate if PE is diagnosed according to clinical practice guidelines.
  
  
  METHODS
  Retrospective study of clinically suspected PE in the emergency department between January 2010 and December 2012. A D-dimer value ≥ 500 ng/ml was considered positive. PE was diagnosed on the basis of the multislice computed tomography angiography and, to a lesser extent, with other imaging techniques. The CPS used was the revised Geneva scoring system.
  
  
  RESULTS
  There was 3,924 cases of suspected PE (56% female). Diagnosis was determined in 360 patients (9.2%) and the incidence was 30.6 cases per 100,000 inhabitants/year. Sensitivity and the negative predictive value of the D-dimer test were 98.7% and 99.2% respectively. CPS was calculated in only 24 cases (0.6%) and diagnostic algorithms were not followed in 2,125 patients (54.2%): in 682 (17.4%) because clinical probability could not be estimated and in 482 (37.6%), 852 (46.4%) and 109 (87.9%) with low, intermediate and high clinical probability, respectively, because the diagnostic algorithms for these probabilities were not applied.
  
  
  CONCLUSIONS
  CPS are rarely calculated in the diagnosis of PE and the diagnostic algorithm is rarely used in clinical practice. This may result in procedures with potential significant side effects being unnecessarily performed or to a high risk of underdiagnosis.
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Sanjuán
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España.
authors.forename: Nuria
authors.initials: N
authors.lastname: Rodríguez-Núñez
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rábade
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España.
authors.forename: Adriana
authors.initials: A
authors.lastname: Lama
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España.
authors.forename: Lucía
authors.initials: L
authors.lastname: Ferreiro
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: González-Barcala
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Alvarez-Dobaño
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Toubes
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Golpe
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España. Electronic address: luis.valdes@mundo-r.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Valdés
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011336:Probability; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Algoritmo diagnóstico; Angiotomografía computarizada multicorte; Clinical probability scores; D-dimer; Diagnostic algorithm; Dímero-D; Embolia pulmonar; Escalas de probabilidad clínica; Multislice computed tomography angiography; Pulmonary embolism