How to Combat Over-Testing for Patients Suspected of Pulmonary Embolism: A Narrative Review

The diagnosis of PE remains difficult in 2023 because the signs and symptoms are not sensible nor specific. The consequences of potential diagnostic errors can be dramatic, whether by default or by excess. Furthermore, the achievement of a simple diagnostic strategy, based on clinical probability as...

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Bibliographic Details
Published inDiagnostics (Basel) Vol. 13; no. 7; p. 1326
Main Authors Roy, Pierre-Marie, Moumneh, Thomas, Bizouard, Thomas, Duval, Damien, Douillet, Delphine
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 01.04.2023
MDPI
Subjects
Angiography
Anticoagulants
Contrast agents
CT imaging
Diagnosis
diagnostic
Emergency medical care
Investigations
Medical errors
Medical imaging
Methods
Mortality
over-testing
Pulmonary arteries
Pulmonary embolism
Pulmonary embolisms
Radiation
Review
Scintigraphy
Thromboembolism
Thrombosis
France
United States > US
pulmonary embolism
over-testing
diagnostic
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Summary:The diagnosis of PE remains difficult in 2023 because the signs and symptoms are not sensible nor specific. The consequences of potential diagnostic errors can be dramatic, whether by default or by excess. Furthermore, the achievement of a simple diagnostic strategy, based on clinical probability assessment, D-dimer measurement and computed tomography pulmonary angiography (CTPA) leads to a new challenge for PE diagnosis: over-testing. Indeed, since the 2000s, the wide availability of CTPA resulted in a major increase in investigations with a mod I confirm erate increase in PE diagnosis, without any notable improvement in patient outcomes. Quite the contrary, the complications of anticoagulation for PE increased significantly, and the long-term consequences of imaging diagnostic radiation is an important concern, especially the risk of breast cancer for young women. As a result, several strategies have been proposed to fight over-testing. They are mostly based on defining a subgroup of patients for whom no specific exam should be required to rule-out PE and adjusting the D-dimer cutoff to allow the exclusion of PE without performing CTPA. This narrative review presents the advantages and limitations of these different strategies as well as the perspective in PE diagnosis.
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ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics13071326