Methodology for a rapid protocol to rule out pulmonary embolism in the emergency department

Ann Emerg Med. 2003 Aug;42(2):266-75. doi: 10.1067/mem.2003.268.

Abstract

We propose an emergency department (ED) pulmonary embolism rule-out protocol based on pretest probability assessment coupled with either a negative D -dimer assay result or a negative D -dimer assay result plus a normal alveolar dead-space measurement. We examine the safety, efficiency, and feasibility of such a protocol, paying special attention to implicit and explicit strategies of pretest probability assessment among patients with suspected pulmonary embolism. Finally, we assess the potential effect of the proposed pulmonary embolism rule-out protocol on use of imaging resources and ED throughput.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms
  • Clinical Protocols / standards
  • Decision Trees
  • Diagnosis, Differential
  • Efficiency
  • Emergency Treatment / methods*
  • Emergency Treatment / standards
  • Enzyme-Linked Immunosorbent Assay / standards
  • Erythrocyte Aggregation
  • Evidence-Based Medicine
  • Feasibility Studies
  • Fibrin Fibrinogen Degradation Products / metabolism*
  • Humans
  • Immunoassay / standards
  • Latex Fixation Tests / standards
  • Length of Stay
  • Point-of-Care Systems / standards
  • Pulmonary Alveoli*
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / etiology
  • Respiratory Dead Space*
  • Risk Assessment
  • Risk Factors
  • Safety
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Time Factors

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D