Are Diagnostic Algorithms for Suspected Pulmonary Embolism Applicable in French Emergency Departments?

Abstract number: P1049

Roy¹ PM, Furber¹ A, Roupie² E, Honnart³ D, Soulat⁴ L, Meyer⁵ G

¹¹University hospital of Angers, Angers, France ¹¹University hospital of Angers, Angers, France ²²University hospital Henry Mondor, Créteil, France ³³University hospital of Dijon, Dijon, France ⁴⁴General hospital of Chateauroux, Chateauroux, France ⁵⁵University hospital Georges Pompidou, Paris, France

Aims:  To assess the applicability of diagnostic strategies for pulmonary embolism suspicion whether they are based on V/Q scan or on spiral CT.

Methods:  A questionnaire was send to the physician in charge of the Emergency Department of the 492 French public hospitals. We obtained 261 answers (53%).

Results:  A strategy based on D-dimer, venous ultrasonography and spiral CT was applicable at working hours in 64% of the centres as compared to 23% for a strategy based on D-dimer, venous ultrasonography and lung scan (P < 0.001). All the centres that had V/Q scan or pulmonary angiography facility had spiral CT facility too, 11% of the centres had access to spiral CT but had no venous ultrasonography facility, 13% had venous ultrasonography facility but no spiral CT, and 11% had no venous ultrasonography and no spiral CT facility. D-dimer test was available in 98% of the centres and 83% declared performing a D-dimer test in all patients with suspected pulmonary embolism. A written diagnostic algorithm was available in 44 centres (17%) and a clinical probability rule in 34 centres (13%).

Conclusion:  Since the advent of spiral CT, the majority of patients who seek emergency care with suspected pulmonary embolism in France can benefit from a valid non-invasive diagnostic strategy. However, the lack of local guidelines may hamper a proper diagnostic management as suggested by the high rate of D-dimer testing systematically performed.