Clinical features compatible with PE

Posted 3 February, 2008 - 12:57 by steve

Clinical features compatible with PE include

Breathlessness *
Tachypnoea (RR>20)
Pleuritic Chest Pain
Haemoptysis

Clinical risk score

Risk factors for PE Score Patient's score
Clinical signs/symptoms of DVT 3 points  
PE as or more likely than any alternative diagnosis ** 3 points  
Heart rate > 100 bpm 1.5 points  
Immobilisation or surgery in previous 4 weeks 1.5 points  
Previous DVT/PE 1.5 points  
Haemoptysis 1 point  
Malignancy 1 point  
TOTAL    

Clinical Probability of PE

LOW <2 points
INTERMEDIATE 2-6 points
HIGH >6 points

* Most patients with PE are breathless or tachypnoeic. In the absence of these, pleuritic chest pain or haemoptysis is usually due to another cause

** All pregnant patients who present with signs or symptoms suggestive of PE should be referred direct to radiology - d-dimer is not indicated. Similarly patients readmitted within 3 months of negative d-dimer and with signs and symptoms suggestive of PE should have clinical probabily estimated and referred directly to radiology without d-dimer testing.

Please note:

  • All requests for d-dimer assay should include the clinical pre test probability in the request details.
  • All radiology requests must include the following information or Radiology will not accept requests for CTPA or VQ scanning:
  1. Relevant clinical information
  2. Clinical probability of PE - High, moderate or Low
  3. CXR result
  4. d-dimer result for those with moderate or low clinical probability

All patients with high probability of PE and all patients with intermediate or low probability of PE with positive d-dimer assay must be started on anti-coagulation treatment whilst awaiting radiology examinations.