Template:Pulmonary embolism - need for investigation and choice of modality
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Need for investigation
The indication can effectively be determined by clinical scoring, followed by D-dimer in those less likely to have pulmonary embolism.[1] By Well's score, CT is indicated at a score over 4:[1]
| Feature | Points |
|---|---|
| Signs and symptoms of deep vein thrombosis, at least with leg swelling and pain upon palpation of deep veins. | 3 |
| No alternative diagnosis better explains the presentation | 3 |
| Heart rate over 100/min | 1.5 |
| Immobilization >3 days or surgery in past 4 weeks | 1.5 |
| Previous pulmonary embolism or deep vein thrombosis | 1.5 |
| Hemoptysis | 1 |
| Malignancy (current or treated in the past 6 months) | 1 |
Choice of modality
In pregnant and elderly patients, corresponding D-dimer ranges need to be used.<ref group="notes">
- Pregnant patients
The following are reference ranges for D-dimer:
| Units | Nonpregnant adult |
First trimester | Second trimester | Third trimester |
|---|---|---|---|---|
| mg/L or µg/mL | < 0.5 | 0.05 - 0.95 | 0.32 - 1.29 | 0.13 -1.7 |
| µg/L or ng/mL | < 500 | 50 - 950 | 320 - 1290 | 130 - 1700 |
| nmol/L | < 2.7 | 0.3 - 5.2 | 1.8 - 7.1 | 0.7 - 9.3 |
Reference: Reference Values During Pregnancy at perinatology.com. Retrieved October 2014.
- Elderly patients
Patient’s age in years × 10 µg/L (or x 0.056 nmol/L) for patients aged over 50 years for the suspicion of venous thromboembolism (VTE).
References:
". J Fam Pract 63 (3): 155–8. March 2014. PMID 24701602.
- Raja, Ali S.; Greenberg, Jeffrey O.; Qaseem, Amir; Denberg, Thomas D.; Fitterman, Nick; Schuur, Jeremiah D. (29 September 2015). "Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians
". Annals of Internal Medicine 163 (9): 701. doi:. PMID 26414967.
