Testing low-risk patients for suspected pulmonary embolism: a decision analysis

Area of Science:

• Emergency Medicine
• Clinical Decision Modeling

Background:

• The Pulmonary Embolism Rule-out Criteria (PERC) aids in managing suspected pulmonary embolism in emergency departments.
• PERC identifies low-risk patients eligible for deferred diagnostic testing.

Purpose of the Study:

• To develop a decision model refining the pulmonary embolism testing threshold beyond PERC criteria.
• To identify key risk and benefit factors influencing the pulmonary embolism evaluation threshold.

Main Methods:

• Decision models were constructed for low-risk patients meeting PERC criteria.
• Sensitivity analyses (one-way and two-way) determined the testing threshold and its primary drivers.

Main Results:

• An average testing threshold of 1.4% was calculated across patient cohorts.
• Major bleeding risk from anticoagulation, contrast-induced renal failure mortality, CT scan cancer risk, and PE mortality significantly impacted the threshold.

Conclusions:

• The derived testing threshold aligns with established methods but uses different assumptions.
• Key drivers of the pulmonary embolism testing threshold lack sufficient supporting literature for precise assessment in low-risk patients.