Paul D. Stein, MD, Pamela K. Woodard, MD, John G. Weg, MD, Thomas W

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Presentation transcript:

Diagnostic Pathways in Acute Pulmonary Embolism: Recommendations of The PIOPED II Investigators Paul D. Stein, MD, Pamela K. Woodard, MD, John G. Weg, MD, Thomas W. Wakefield, MD, Victor F. Tapson, MD, H. Dirk Sostman, MD, Thomas A. Sos, MD, Deborah A. Quinn, MD, Kenneth V. Leeper, MD, Russell D. Hull, MBBS, MSc, Charles A. Hales, MD, Alexander Gottschalk, MD, Lawrence R. Goodman, MD, Sarah E. Fowler, PhD, John D. Buckley, MD, MPH The American Journal of Medicine Volume 119, Issue 12, Pages 1048-1055 (December 2006) DOI: 10.1016/j.amjmed.2006.05.060 Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 1 Pathway for D-dimer by quantitative rapid ELISA in combination with clinical assessment. If clinical assessment is low or moderate probability, and D-dimer rapid ELISA is negative, pulmonary embolism would be excluded. If clinical assessment is high probability, further testing is necessary irrespective of the results of D-dimer testing. ELISA=enzyme-linked immunosorbent assay. The American Journal of Medicine 2006 119, 1048-1055DOI: (10.1016/j.amjmed.2006.05.060) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 2 Pathway for diagnosis with CT angiography or CT angiography/CT venography following testing with D-dimer in combination with low probability clinical assessment. CT angiography = contrast-enhanced multidetector computed tomographic pulmonary angiography; CT venography = contrast-enhanced multidetector computed tomographic venous phase imaging of the veins of the lower extremities; NPV = negative predictive value; PPV = positive predictive value. The American Journal of Medicine 2006 119, 1048-1055DOI: (10.1016/j.amjmed.2006.05.060) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 3 Pathway for diagnosis with CT angiography or CT angiography/CT venography following testing with D-dimer in combination with moderate probability clinical assessment. CT angiography = contrast-enhanced multidetector computed tomographic pulmonary angiography; CT venography = contrast-enhanced multidetector computed tomographic venous phase imaging of the veins of the lower extremities; NPV = negative predictive value; PPV = positive predictive value. The American Journal of Medicine 2006 119, 1048-1055DOI: (10.1016/j.amjmed.2006.05.060) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 4 Pathway for diagnosis with CT angiography or CT angiography/CT venography in patients with a high probability clinical assessment. CT angiography = contrast-enhanced multidetector computed tomographic pulmonary angiography; CT venography = contrast-enhanced multidetector computed tomographic venous phase imaging of the veins of the lower extremities; NPV = negative predictive value; PPV = positive predictive value. The American Journal of Medicine 2006 119, 1048-1055DOI: (10.1016/j.amjmed.2006.05.060) Copyright © 2006 Elsevier Inc. Terms and Conditions