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Outpatient investigation of pulmonary embolism
  1. Kerstin Hogg, Clinical Research Fellow,
  2. Debbie Dawson, Clinical Research Nurse
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones:man.ac.uk

    Abstract

    A short cut review was carried out to establish whether outpatient investigation of suspected pulmonary embolus is a safe strategy. A total of 198 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

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    Report by Kerstin Hogg,Clinical Research FellowChecked by Debbie Dawson, Clinical Research Nurse

    Clinical scenario

    A 38 year old man presents to the emergency department with left posterior pleuritic chest pain. He had a DVT eight years ago and his d-dimer levels are raised. He is haemodynamically stable with normal oxygen saturations, ECG, and chest radiograph. You would like to rule out a pulmonary embolism, but it is 8 pm. You wonder whether it would be safe to discharge the patient home overnight before his VQ scan tomorrow.

    Three part question

    In a [patient with suspected pulmonary embolism] is [outpatient investigation] [safe]?

    Search strategy

    Medline 1966–04/03 using the OVID interface. [(pulmonary embol$.mp OR exp Pulmonary Embolism OR PE.mp OR exp Thromboembolism OR pulmonary infarct$.mp) AND (diagnosis.mp OR exp Diagnosis) AND (outpatient.mp OR exp Outpatients OR clinic.mp OR exp Outpatent clinics, hospital)] LIMIT to human AND English.

    Search outcome

    Altogether 198 papers were found, one of which looked at outpatient investigation of patients with suspected PE. This is shown in table 9.

    Table 9

    Comments

    This is the only published study looking at outpatient investigation of PE and is small. Further research is needed.

    CLINICAL BOTTOM LINE

    It may be safe to investigate selected patients with suspected pulmonary embolus at home.

    Report by Kerstin Hogg,Clinical Research FellowChecked by Debbie Dawson, Clinical Research Nurse

    References

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