Diagnostic strategies for suspected pulmonary embolism among outpatients

Diagnosis of pulmonary embolism (PE) has been made easier, less invasive, and somewhat safer over the past 2 decades. This has been due mainly to the development of lung scan and to the recognition of VTE as an entity comprising deep vein thrombosis and PE. The prevalence of the disease in patients clinically suspected of PE has steadily decreased during the past 10 years. This has led to the development of diagnostic tools that aim at reducing the number of unnecessary pulmonary angiograms. These include clinical probability assessment and fibrin D-dimer. Several strategies combining these tools have been validated in large outcome studies and compared in a formal cost-effectiveness analysis. The results indicate that they should now be implemented in daily practice taking into account local facilities and expertise. The exact place of helical computed tomography in such sequential algorithms remains to be established.