[Diagnostic strategies for pulmonary embolism and decision analysis]

Decision analysis has greatly benefited to the field of pulmonary embolism diagnosis, by allowing the theoretical assessment of potential novel strategies, which could in turn be validated in clinical trials. The adjunction of clinical probability assessment, plasma D-dimer measurement, and lower limb venous compression ultrasonography, to pulmonary scintigraphy and angiography in the diagnostic workup, results in a considerable reduction in the requirement for angiography. Moreover, these strategies are highly cost-effective, yielding cost savings without increasing morbidity or mortality. Such diagnostic algorithms are safe, as demonstrated by clinical outcome studies. Finally, spiral CTscan combined with D-dimer and ultrasonography could also prove highly cost-effective, and replace either pulmonary angiography, or even both lung scan and angiography, if ongoing studies confirm the promising preliminary results obtained with CTscan. However, such a conclusion awaits the validation of algorithms including CTscan by clinical outcome trials, in which the therapeutic decision would rest on the result of the spiral CTscan.