Diagnostic work-up of patients with suspected pulmonary embolism: a survey of strategies used by emergency physicians

PURPOSE In this study, we aimed to document imaging practices and diagnostic strategies used by emergency physicians in patients with suspected high-probability pulmonary embolism (PE). MATERIALS AND METHODS A questionnaire investigating the diagnostic strategies used by the emergency physicians in the evaluation of venous thromboembolism was mailed electronically to all emergency department residents and specialists practicing in 62 medical institutions in Turkey. The questionnaire gathered information about the availability and frequency of use of diagnostic imaging modalities in different scenarios in patients with suspected high-probability PE. RESULTS Echocardiography, helical computed tomography (CT), and D-dimer test were the most available tools around the clock with a frequency of use of 78%, 73%, and 67%, respectively. One hundred and nineteen of 176 respondents (68%) reported that they request D-dimer "invariably" before performing an imaging examination in patients with suspected high-probability PE (SHPPE). Before ordering advanced imaging, 136 EPs (77%) would always obtain chest radiographs. Fifty-four residents (55%) and 39 specialists (51%) indicated that CTPA would likely be the first examination for patients with SHPPE and with signs of deep venous thrombosis (DVT) (P = 0.8). The most frequently selected examination for patients with SHPPE and without signs of DVT was CTPA, reported by 69 of the residents (70%) and 53 of the specialists (69%) (P = 0.9). CONCLUSION This survey did not show significant variations either in the practices and policies used by emergency physicians, or in the methodological approaches between specialists and residents. Among the imaging modalities, CTPA was the tool most preferred by physicians for patients with suspected acute PE.