Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators.


Journal Article

PURPOSE: To formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on randomized trials. METHODS: Diagnostic management recommendations were formulated based on results of the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) and outcome studies. RESULTS: The PIOPED II investigators recommend stratification of all patients with suspected pulmonary embolism according to an objective clinical probability assessment. D-dimer should be measured by the quantitative rapid enzyme-linked immunosorbent assay (ELISA), and the combination of a negative D-dimer with a low or moderate clinical probability can safely exclude pulmonary embolism in many patients. If pulmonary embolism is not excluded, contrast-enhanced computed tomographic pulmonary angiography (CT angiography) in combination with venous phase imaging (CT venography), is recommended by most PIOPED II investigators, although CT angiography plus clinical assessment is an option. In pregnant women, ventilation/perfusion scans are recommended by many as the first imaging test following D-dimer and perhaps venous ultrasound. In patients with discordant findings of clinical assessment and CT angiograms or CT angiogram/CT venogram, further evaluation may be necessary. CONCLUSION: The sequence for diagnostic test in patients with suspected pulmonary embolism depends on the clinical circumstances.

Full Text

Cited Authors

  • Stein, PD; Woodard, PK; Weg, JG; Wakefield, TW; Tapson, VF; Sostman, HD; Sos, TA; Quinn, DA; Leeper, KV; Hull, RD; Hales, CA; Gottschalk, A; Goodman, LR; Fowler, SE; Buckley, JD; PIOPED II investigators,

Published Date

  • December 2006

Published In

Volume / Issue

  • 119 / 12

Start / End Page

  • 1048 - 1055

PubMed ID

  • 17145249

Pubmed Central ID

  • 17145249

Electronic International Standard Serial Number (EISSN)

  • 1555-7162

International Standard Serial Number (ISSN)

  • 0002-9343

Digital Object Identifier (DOI)

  • 10.1016/j.amjmed.2006.05.060


  • eng