SCCM 2013: Evaluating Pulmonary Embolism in the ED

The Particulars: Previous data suggest that CT pulmonary angiography (CTPA) is the test of choice for pulmonary embolism (PE) in the ED. However, it is not well known how often CTPA is positive for PE. The ultimate disposition and discharge diagnosis for patients evaluated for PE in the ED using CTPA are also not well known.

Data Breakdown: Researchers conducted a retrospective study of 776 ED patients evaluated for PE in the ED using CTPA. CTPA was positive for PE in only 6.6% of cases. Of those diagnosed with PE, 94.1% were admitted—20.9% to a higher level of care—and 5.9% died. Most patients with PE (79.1%) were admitted to the floor. Despite a negative CTPA, 304 patients were admitted—5.3% to a higher level of care—and 1.6% died. The most common diagnosis at admission was non-specific chest pain (44.7%).

Take Home Pearls: CTPA appears to have a low diagnostic yield in the ED for PE. Patients diagnosed with PE often require higher levels of care and appear to have a higher mortality rate. Most patients without PE appear to be admitted and discharged with non-specific findings after negative CTPA.

 

 

 

Physician's Weekly for Current Medical News, Events & Issues