Diagnostic approach to pulmonary embolism in a rural emergency department.

Department of Emergency Medicine, University of Western Ontario and South Huron Hospital Association, Exeter, Ontario.
Canadian journal of rural medicine: the official journal of the Society of Rural Physicians of Canada = Journal canadien de la medecine rurale: le journal officiel de la Societe de medecine rurale du Canada 01/2012; 17(1):17-20.
Source: PubMed


Pulmonary embolism (PE) is a serious condition with mortality estimates of up to 10%. We sought to investigate the diagnosis of PE, time to access imaging and diagnostic utility of each modality in a rural emergency department (Ed).
We completed a retrospective chart review to determine the investigations performed and treatments initiated in the management of suspected PE in a rural hospital.
A total of 47 charts from a 5-year period were reviewed. Of these, 83.0% indicated a D-dimer test was ordered, and 31.9% and 40.4% indicated either ventilation-perfusion (V/Q) or computed tomography (CT) were ordered during the ED visit. Computed tomography diagnosed 11 of the 12 instances of confirmed PE. Mean time to patients undergoing V/Q or CT was 1.58 and 1.59 days, respectively. Low-molecular-weight heparin was started in 83.0% of patients.
In this ED there may be over reliance on the D-dimer test, irrespective of Wells score. Access to V/Q and CT were similar to that of an urban centre. Empiric anticoagulation was started in most patients.

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