Template:Pulmonary embolism - need for investigation and choice of modality
Revision as of 14:44, 19 July 2019 by Mikael Häggström (talk | contribs) (→Choice of modality: Only upper limit necessary)
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 or elderly patients, corresponding D-dimer ranges need to be used.[notes 1]
Further information on modalities:
Notes
- ↑
- Pregnant patients
Units Nonpregnant
adultFirst trimester Second trimester Third trimester mg/L or µg/mL < 0.5 < 0.95 < 1.29 < 1.7 µg/L or ng/mL < 500 < 950 < 1290 < 1700 nmol/L < 2.7 < 5.2 < 7.1 < 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.