Does this patient have pulmonary embolism?

Area of Science:

• Pulmonary Medicine
• Diagnostic Accuracy
• Clinical Decision Making

Background:

• Experienced clinicians' gestalt aids in estimating pulmonary embolism pretest probability.
• The comparability of clinical prediction rules to gestalt for this assessment is unclear.
• Clinical prediction rules could empower less-experienced professionals in diagnosing pulmonary embolism.

Observation:

• A systematic review and meta-analysis evaluated studies comparing clinical gestalt and prediction rules for pulmonary embolism pretest probability.
• Included studies involved consecutive, unselected patients with physicians blinded to diagnostic test results.
• Sixteen studies involving 8306 patients met the inclusion criteria.

Findings:

• Both clinical gestalt and clinical prediction rules demonstrated similar accuracy in stratifying patients into low, moderate, and high pretest probability categories for pulmonary embolism.
• Rates of pulmonary embolism varied across probability groups for both methods, with overlapping ranges.
• Clinical prediction rules showed a wider range of accuracy in some categories compared to gestalt.

Implications:

• Clinical prediction rules are as accurate as experienced clinicians' gestalt in assessing pulmonary embolism pretest probability.
• The use of clinical prediction rules is advocated due to their accuracy and applicability by less-experienced clinicians.
• These rules can simplify pulmonary embolism diagnosis and complement existing diagnostic strategies.