Vol 16, No 5 (2020)

Adherence to the algorithmic approach for diagnosis of pulmonary embolism: A teaching hospital experience, Shiraz, Iran

Vahid Mohammadkarimi, Samaneh Ahsant, Mohammad Hadi Bagheri, Reza Jalli, Ali Hosseinipour, Seyed Masoom Masoompour

DOI: http://dx.doi.org/10.22122/arya.v16i5.2040


BACKGROUND: We evaluated to see if the algorithmic approach of pulmonary embolism (PE) [Wells’ score, followed by D-dimer test and computed tomography pulmonary angiography (CTPA)] is appropriately followed in teaching hospitals of Shiraz, Iran.

METHODS: From October 2012 to October 2013, we prospectively calculated Wells’ score for all patients who underwent CTPA with clinical suspicion to PE; patients with low probability who had not checked the D-dimer or had low level of D-dimer were considered as non-adherent to the guideline and those with high level of D-dimer or high probability of Wells’ score were labeled as adherent to the PE guideline. CTPA scans were independently reported by two radiologists.

RESULTS: During study period, 364 patients underwent CTPA to rule out PE, of which 125 (34.3%) had Wells’ score > 4 (high probable risk) and 239 had Wells’ score ≤ 4. Amongst low probable risk patients (Wells’ score ≤ 4), only 32 patients had undergone the D-dimer test (23 patients had high level of D-dimer). Based on the algorithmic approach, patients with suspected PE, patients with high probability (125 patients), and patients with low probability with elevated D-dimer level
(23 patients) were considered as adherent to the PE guideline; consequently, the total adherence to PE guideline was 148 out of 364 (40.6%).

CONCLUSION: We followed the algorithmic approach guideline in about 40.0% of cases; however, we should pay more attention to the algorithmic approach in patients with suspected PE.


Pulmonary Embolism; Diagnostic Imaging; Tomography; Blood; Spiral Computed Tomography

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