Pulmonary Embolism Risk Scoring

Pulmonary embolism
Physical exam findings:  tachypnea, tachycardia, calf swelling, loud pulmonary component of S2.  Homan’s sign is unreliable and should not be used.
EKG finding of S1Q3T3 is reasonably specific but not sensitive.
Wells’ Criteria for PE—to risk stratify (< 4 = unlikely; > 4 = likely)
  • Clinical sign or symptom of DVT (3)
  • PE is #1 dx or equally likely (3)
  • HR >100 (1.5)
  • Immobilization at lease 3days or surgery in last 4wk (1.5)
  • Previous objectively dx of PE or DVT (1.5)
  • Hemoptysis (1)
  • Malignancy with treatment w/in 6mo or palliative (1)
    • Low risk <2, 1.3% incidence of PE —> d-dimer or PERC
    • Moderate 2-6, 16.2% incidence of PE —> d-dimer or CTA
    • High >6, 37.5% incidence of PE —>CTA
PERC—use if low risk, if any positive must work up; if all negative, no further workup:
  • >50yo
  • HR>100
  • O2 sat on RA <95%
  • Hx of VTE
  • Trauma or surgery within 4wk
  • Hemoptysis
  • Exogenous estrogen
  • Unilateral leg swelling

2012 Guidelines for Prevention and Treatment of DVT, published in Chest (executive summary) –

executive-summaryexecutive-summary-antithrombotic-therapy-and-prevention-of-thr

Risk of PE if mod-high pretest probability but negative D-dimer = 5%

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