Embolism Using an Algorithm Combining Clinical Effectiveness of Managing Suspected Pulmonary

managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295:172-179. You are called to see a cross-cover patient with sudden, unexplained tachycardia and you suspect pulmonary embolism, what is your next step? The Christopher Study prospectively followed a large cohort of patients with suspected PE and implemented a diagnostic algorithm that used a previously validated clinical decision rule (Table 1) to divide the pts into PE “likely ” (>4 points) or “unlikely ” (≤4 points). Those categorized as “unlikely ” received D-Dimer testing, and normal D-Dimer ( ≤ 0.5 ug/ml) excluded the diagnosis of PE with follow-up showing <1 % incidence of venous thromboembolism at 3 months. Pt with “likely ” PE and/or those with abnormal D-Dimer (>0.5 ug/ml) went on to CT, and most of those with negative CT scan did not receive anticoagulation with incidence of VTE on 3 months follow-up at 1.3%. By following the diagnostic algorithm outlined in the Christopher Study, one could begin to approach PE with more certainty and appropriately triage diagnostic studies and treatment. current as of June 14, 2009