Diagnostic approach to pulmonary embolism in a rural emergency department

Introduction: Pulmonary embolism (PE) is a serious condition with mortality estimates of up to 10%. We sought to investigate the diagnosis of PE, time to access imaging and diagnostic utility of each modality in a rural emergency department (Ed). Methods: We completed a retrospective chart review to determine the investigations performed and treatments initiated in the management of suspected PE in a rural hospital. Results: A total of 47 charts from a 5-year period were reviewed. Of these, 83.0% indicated a d-dimer test was ordered, and 31.9% and 40.4% indicated either ventilationperfusion (V/Q) or computed tomography (CT) were ordered during the Ed visit. Computed tomography diagnosed 11 of the 12 instances of confirmed PE. Mean time to patients undergoing V/Q or CT was 1.58 and 1.59 days, respectively. Low-molecular-weight heparin was started in 83.0% of patients. Conclusion: In this Ed there may be overreliance on the d-dimer test, irrespective of Wells score. Access to V/Q and CT were similar to that of an urban centre. Empiric anticoagulation was started in most patients.