Integrated diagnostic approach of patients with suspected pulmonary embolism

In patients with clinically suspected pulmonary embolism (PE) many diagnostic tests are available and have been widely evaluated. An integrated diagnostic approach is the most efficient way to make management decisions. This is best accomplished by the use of a diagnostic algorithm consisting of a dichotomous decision rule, D-dimer testing and computed tomographic pulmonary angiography (CTPA), or as alternative V-Q lung scanning. Such an algorithm can guide treatment decisions with a low risk for false negative outcome in patients in whom tests indicate that PE is ruled out. No further diagnostic testing is necessary in patients with unlikely clinical probability in combination with a normal D-dimer test result. CTPA or V/Q scans can safely rule out PE in patients with a likely pre-test probability or elevated D-dimer test result.