{"id":630,"date":"2013-05-28T14:52:00","date_gmt":"2013-05-28T14:52:00","guid":{"rendered":"http:\/\/www.emlitofnote.com\/?p=630"},"modified":"2016-08-01T08:58:04","modified_gmt":"2016-08-01T15:58:04","slug":"the-em-lit-of-note-pe-decision-tree","status":"publish","type":"post","link":"https:\/\/www.emlitofnote.com\/?p=630","title":{"rendered":"The EM Lit of Note PE Decision Tree"},"content":{"rendered":"
A couple weeks back I posted<\/a> regarding a study where even intermediate- and high-risk patients with suspected PE had negative CTA in the presence of low d-Dimers.  Based on that post, I’ve put together a rough decision tree encapsulating how I (currently) prefer to approach the diagnosis of pulmonary embolism:<\/div>\n
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Note that “Scan for PE” really means to be “offer patient scan for PE”, considering relevant diagnostic uncertainty and risks in a shared decision-making process.  “Other reason why d-Dimer would be elevated” takes into account clinical judgement regarding the uselessness of d-Dimer as an acute-phase reactant or inflammatory marker; many “sick” patients will have elevated d-Dimers, obviating its value as a one-way screen-out.  Also, this chart does not account for any medicolegal liability risks \u2013 a wonderful perk of practicing in Texas.<\/div>\n
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Follow-up:  Seth Trueger<\/a> and John Greenwood<\/a> pointed out on the original that there are some specific moderate- and high-risk cases that satisfy PERC criteria, and perhaps the risk-stratification step should occur before application of PERC, as is traditionally done.  Fair enough!  They also note the EMCrit flow-chart<\/a> begins with an exhortation of “Did you really<\/i> care about PE?” \u2013 which, I’d say, is approximated by my value judgement of “Bad miss?” after starting to consider PE.  Finally, Scott Weingart<\/a> chimed in to suggest, for patients in whom you’re playing the minimal-harm game for unexciting pulmonary emboli, a bedside ultrasound to quickly check for an occult DVT that might cause them to come back with clinically significant pulmonary venous thrombosis.<\/div>\n\n
Tweet<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

A couple weeks back I posted regarding a study where even intermediate- and high-risk patients with suspected PE had negative CTA in the presence of low d-Dimers.  Based on that post, I’ve put together a rough decision tree encapsulating how I (currently) prefer to approach the diagnosis of pulmonary embolism: Note that “Scan for PE” … Continue reading “The EM Lit of Note PE Decision Tree”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[5,4],"tags":[],"class_list":["post-630","post","type-post","status-publish","format-standard","hentry","category-clinical-decision-rules","category-pulmonary-embolism"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7KesJ-aa","_links":{"self":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/630","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=630"}],"version-history":[{"count":1,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/630\/revisions"}],"predecessor-version":[{"id":2657,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/630\/revisions\/2657"}],"wp:attachment":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=630"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=630"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=630"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}