Current Approach to the Diagnosis of Acute Nonmassive Pulmonary Embolism (Review)

Moores LK et al. Current Approach to the Diagnosis of Acute Nonmassive Pulmonary Embolism. CHEST 2011;140:509-518.  Review.

Where is the best area under the curve, or the "overdiagnosis sweet spot?" It seems no approach gets us off the hook as we seek to avoid anticoagulating people without PEs (without missing any, of course):

• CT-angiography  is more sensitive and accurate, but probably overdiagnoses due to the 5-9% rate of subsegmental PEs of questionable clinical significance.

• Noninvasive algorithms/decision trees (as are promoted here) probably tend toward overcalling PE as well (see prev post), and miss occasional PEs (see another previous post).

So, the search continues ...