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Pulmonary embolism diagnosis: clinical assessment at the front door
  1. John Cafferkey1,
  2. Philippa Serebriakoff1,
  3. Kerstin de Wit2,3,
  4. Daniel E Horner4,5,
  5. Matthew James Reed1,6
  1. 1Emergency Medicine Research Group Edinburgh (EMERGE), NHS Lothian, Edinburgh, UK
  2. 2Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
  3. 3Department of Medicine, McMaster University, Ontario, Canada
  4. 4Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK
  5. 5Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
  6. 6Acute Care Group, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
  1. Correspondence to Professor Matthew James Reed, Emergency Medicine Research Group Edinburgh (EMERGE), NHS Lothian, Edinburgh, EH16 4SA, UK; mattreed{at}ed.ac.uk

Abstract

This first of two practice reviews addresses pulmonary embolism (PE) diagnosis considering important aspects of PE clinical presentation and comparing evidence-based PE testing strategies. A companion paper addresses the management of PE. Symptoms and signs of PE are varied, and emergency physicians frequently use testing to ‘rule out’ the diagnosis in people with respiratory or cardiovascular symptoms. The emergency clinician must balance the benefit of reassuring negative PE testing with the risks of iatrogenic harms from over investigation and overdiagnosis.

  • pulmonary embolism
  • emergency care systems
  • thrombo-embolic disease
  • diagnosis

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Footnotes

  • Handling editor Richard Body

  • Twitter @mattreed73

  • Contributors All authors contributed to the design, structure and writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. No funding was used for the preparation of this manuscript. MJR is currently appointed as professor of the Royal College of Emergency Medicine and is supported by an NHS Research Scotland Career Researcher Clinician award. DEH has specific NIHR funding relevant to a thrombosis research project (NIHR127454).

  • Competing interests JC, PS, KdW and MJR have no conflicts of interest to declare. DEH was a topic expert for NICE NG158 and QS201, regarding the diagnosis and management of venous thromboembolic disease and venous thromboembolism in adults, respectively. DEH was also a coauthor on the BTS guidelines for the outpatient management of pulmonary embolism and the accompanying national quality standards.

  • Provenance and peer review Not commissioned; externally peer reviewed.