Last night as I lay awake in bed, wired from the medrol dose-pack I’m taking for sciatic nerve inflammation due to raking gravel to fill in my driveway’s mud and ice holes, I reviewed my folder of Pulmonary Embolism articles. I learned a few things. First, there is no single algorithm accepted as the standard of care for diagnosing PE except in the extreme cases (absolutely present, or absolutely absent). PE has been considered to both overdiagnosed AND underdiagnosed. How can this be the case? Joe Lex, a fantastic speaker and ER doc, has a great hyperlinked review of the history, controversies and current thinking on evaluating PE and why we can’t yet diagnose such a potentially deadly disease.
In this review, he explicity describes no less than EIGHT different algorithms by many different authors in fields such as internal medicine, emergency medicine and radiology. He presents the strengths and weaknesses of the various studies as well as 10 different myths in evaluating patients for PE. I highly recommend that you review his article to stimulate your thinking about the field, and examine his extensive bibliography (partially annotated).