Check out the best practices at: http://annals.org/article.aspx?articleid=2443959
ACP Best Practices for Pulmonary Embolism:
- Use validated clinical prediction rules to estimate pretest probability
- Do not obtain D Dimer or imaging in patients with low pretest probability of PE and meet PERC RO criteria
- Get a D Dimer, and NOT imaging in:
- Moderate pretest probability
- Low pretest probability who do not meet all PERC rule out criteria
- Use age adjusted D dimer thresholds in patients >50yo
- Calculation: Age x 10ng/mL
- Do not get imaging in patients with D Dimer below age adjusted cutoff
- If high pretest probability, then:
a. Get CT angio pulm arteries
b. V-Q scan if cannot get CTPA
c. Do not get D Dimer