Availability of diagnostic facilities in the Netherlands for patients with suspected pulmonary embolism
ABSTRACT Pulmonary embolism remains a complex diagnostic problem. Although accurate and cost-effective, the ‘Dutch consensus’ strategy is not widely applied. We assessed the availability and investment plans of the different facilities used in this strategy. Furthermore, the current and future availability of new diagnostic modalities was investigated. A questionnaire was sent to all Dutch hospitals. The questionnaire contained separate sections with questions for the hospital management and the medical practitioners at the departments of radiology, nuclear medicine, internal medicine and pulmonology. Five hundred and eighty-four questionnaires were sent out (response rate 68%). Forty-three percent of the hospitals had no nuclear medicine facility, 11% had no pulmonary angiography facility, and 59% had no spiral CT scan (SCTA). Forty-six percent of the responding hospitals had a nuclear medicine facility; and 5% used Technegas for ventilation studies. Strategies with SCTA were available in about 27% of the hospitals. Due to future investments this number will increase to approximately 55%. Strategies with Technegas were available in 2.4% of the hospitals, this number might increase to 25% if Technegas is proven accurate. The ‘Dutch consensus’ strategy is available in two-thirds of the hospitals. All other strategies were less feasible. Several equivalent strategies for diagnosing pulmonary embolism should be developed. These strategies should be accurate, widely available and accepted.
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ABSTRACT: Background: Diagnosing or excluding pulmonary embolism is a complex challenge. Many diagnostic instruments can be used in patients with clinically suspected pulmonary embolism nowadays, all with their own (dis-)advantages. Methods/objectives: In this review, these (dis-)advantages are discussed for the following diagnostic instruments: clinical probability assessment, D-dimer concentration, the combination of clinical probability assessment and D-dimer concentration, bilateral compression ultrasonography, ventilation/perfusion scintigraphy, computerized tomographic pulmonary angiography, pulmonary angiography and magnetic resonance pulmonary angiography. A diagnostic strategy, which can be adjusted to local facilities, is provided and discussed. Conclusion: Using combinations of some of these diagnostic tools, many diagnostic strategies are possible and every hospital should make its own local protocol suited for the local situation.Expert Opinion on Medical Diagnostics 02/2008; 2(2):171-81.