Diagnostic standards for PE - prof. Tomasz Rakowski

diagnostic standards for pulmonary embolism

Tomasz RakowskiJagiellonian University Medical College

Krakow, Poland

Diagnosis

Throughout these guidelines and for the purpose of clinical management, ‘confirmed PE’ is understood as a probability of PE high enough to indicate the need for PE-specific treatment and ‘excluded PE’ as a probability of PE low enough to justify withholding specific PE-treatment with an acceptably low risk despite a clinical suspicion of PE. These terms are not meant to indicate absolute certainty regarding the presence or absence of embolii in the pulmonary arterial bed.

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Severity of pulmonary embolism

The severity of PE should be understood as an individual

estimate of PE-related early mortality risk rather than the

anatomical burden and the shape and distribution of

intrapulmonary emboli. Therefore, current guidelines suggest

replacing potentially misleading terms such as ‘massive’,

‘submassive’ and ‘non-massive’ with the estimated level of

the risk of PE-related early death.

Principal markers useful for risk stratification

Risk stratification according to expected pulmonary embolism-related early mortality rate

a In the presence of shock or hypotension it is not necessary to confirm RV dysfunction/injury to classify as high risk of PE-related early mortality.

Clinical prediction rules for PERevised Geneva score Wells score

Simplified clinical prediction rules for PERevised Geneva score Wells score

+1+1+1+1

+1+1+1

+1+1

+1+1+1

+1

+1

+1

+1

PE unlikely: 0 to 1; PE likely: 2 or moreLow: 0 to 1; intermediate: 2 to 4; high: 5+PE unlikely: 0 to 2; PE likely: 3 or more

Thromb Haemost 2009;101:197-200Arch Intern Med. 2008;168:2131-6

Validated diagnostic criteria for diagnosing PE in patients without shock and hypotension (non-high-risk PE)

according to clinical probability

Validated diagnostic criteria for diagnosing PE in patients without shock and hypotension (non-high-risk PE)

according to clinical probability