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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.
.
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