title: Importance of risk factors for the evaluation of patients with a suspected pulmonary embolism.
abstract: The reliable exclusion of a pulmonary embolism (PE) in hemodynamically stable patients remains a challenge. The European Society of Cardiology guidelines for PE diagnosis published in 2008 and updated in 2014 recommend a low-threshold computed tomography (CT) indication for patients with a high probability of pulmonary embolism or those with elevated levels of D-dimers. Certain elements of the recommendations are controversial, while others, including the evaluation of the risk factors for PE, are considered only in individual cases. In the present study, various risk factors, including obesity, smoking, contraceptive use, immobility level, history of malignant disease and thrombophilia and the factors of familial predisposition, deep vein thrombosis (DVT)/PE-history, long-distance flying <1 week and surgery <4 weeks previously, were retrospectively examined in 492 patients with a suspected PE. The data demonstrated a significant risk of PE with contraceptive use, a history of DVT/PE and thrombophilia. The immobility level, surgery <4 weeks and long-distance flying <1 week previously, as well as family history, malignant disease, obesity and smoking, were not observed to be associated with a significantly higher risk of PE. Contraceptive use and thrombophilia, in addition to a history of DVT/PE, each appear to have a significant predictive value in the context of PE risk stratification. Therefore, patients with a suspected PE, who additionally present with at least one of the aforementioned risk factors, should undergo further diagnostic steps for PE risk stratification, including a low-threshold CT examination, even in the absence of elevated D-dimers.
authors.affiliation: Emergency Department, Heidelberg University, Mannheim, Baden-Württemberg D-68167, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Gruettner
authors.affiliation: Clinic for Anesthesiology and Operative Intensive Medicine, Heidelberg University, Mannheim, Baden-Württemberg D-68167, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Viergutz
authors.affiliation: Emergency Department, Heidelberg University, Mannheim, Baden-Württemberg D-68167, Germany.
authors.forename: Merle
authors.initials: M
authors.lastname: Bolte
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg D-68167, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg D-68167, Germany.
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg D-68167, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Sudarski
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg D-68167, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Apfaltrer
authors.affiliation: Emergency Department, Heidelberg University, Mannheim, Baden-Württemberg D-68167, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walter
keywords: emergency department; pulmonary embolism; risk factors