title: Emergency Evaluation for Pulmonary Embolism, Part 1: Clinical Factors that Increase Risk.
abstract: BACKGROUND
  Pulmonary embolism (PE) can be fatal, but profligate testing for PE can harm patients.
  
  
  OBJECTIVE
  With consideration of potential medicolegal implications, this two-part review provides current evidence about the care of patients with suspected and diagnosed PE in the emergency department (ED) setting.
  
  
  CONCLUSIONS
  In part 1, we review published evidence to describe the epidemiology, risk factors, and clinical presentation of PE in the ED setting. Older age, surgery requiring endotracheal intubation within the past 30 days, new use of oral contraceptives, and prior unprovoked venous thromboembolism in nonanticoagulated patients are clear risk factors for PE in ED patients. Recent history of unexplained dyspnea, pleuritic chest pain, and hemoptysis increase probability, but the effect of syncope is less clear. Treated and inactive cancer, smoking, obesity, and pregnancy have not been found to increase the probability of PE in symptomatic ED patients. Unexplained dyspnea, tachycardia, and a low pulse oximetry reading increase probability of PE. Finding of wheezing on lung auscultation reduces the probability of PE, and findings that suggest deep venous thrombosis increase the probability of PE.
  
  
  CONCLUSIONS
  Understanding of risk factors, historical data, and physical findings that have been found to increase or decrease the probability of PE in symptomatic ED patients can help create rational guidelines for the diagnostic approach to PE.
authors: Department of Emergency Medicine and Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Jeffrey A
authors: JA
authors: Kline
authors: Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital and Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
authors: Christopher
authors: C
authors: Kabrhel
mesh_terms: D000367:Age Factors; D002637:Chest Pain / Q000453:epidemiology; D003276:Contraceptives, Oral; D004417:Dyspnea / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D006469:Hemoptysis / Q000453:epidemiology; D006801:Humans; D007442:Intubation, Intratracheal; D010100:Oxygen / Q000097:blood; D011247:Pregnancy; D011336:Probability; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D012135:Respiratory Sounds; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D013610:Tachycardia / Q000453:epidemiology
chemical_list: D003276:Contraceptives, Oral; D010100:Oxygen
keywords: decision making; defensive medicine; diagnosis; medicolegal; pregnancy; pulmonary embolism; venous thromboembolism