pulmonary embolism evaluation
the Clinical Guidelines Committee of the Am College of Physicians published a paper detailing what they consider to be "best practice advice" for the evaluation of patients with suspected acute pulmonary embolism --PE-- ( see pulm embolism eval best practice annals2015 in dropbox, or doi:10.7326/M14-1772), focusing on what they see as the overuse of CT scans and plasma D-dimer tests. their advice: --use validated clinical prediction rules to estimate the pretest probability of PE (eg Wells prediction rules or revised Geneva score, included below) --patients who have low pretest probability of PE and who also meet all of the Pulmonary Embolism Rule-Out Criteria (PERC, included below) should NOT have a D-dimer done --patients with an intermediate pretest probability of PE, or low pretest probability but do not meet all of the PERC, should have a high-sensitivity D-dimer done --in patients over 50yo, use age-adjusted D-dimer thresholds (agex10ng/ml, ra...