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How to Combat Over-Testing for Patients Suspected of Pulmonary Embolism: A Narrative Review

The diagnosis of PE remains difficult in 2023 because the signs and symptoms are not sensible nor specific. The consequences of potential diagnostic errors can be dramatic, whether by default or by excess. Furthermore, the achievement of a simple diagnostic strategy, based on clinical probability as...

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Autores principales: Roy, Pierre-Marie, Moumneh, Thomas, Bizouard, Thomas, Duval, Damien, Douillet, Delphine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10093278/
https://www.ncbi.nlm.nih.gov/pubmed/37046544
http://dx.doi.org/10.3390/diagnostics13071326
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author Roy, Pierre-Marie
Moumneh, Thomas
Bizouard, Thomas
Duval, Damien
Douillet, Delphine
author_facet Roy, Pierre-Marie
Moumneh, Thomas
Bizouard, Thomas
Duval, Damien
Douillet, Delphine
author_sort Roy, Pierre-Marie
collection PubMed
description The diagnosis of PE remains difficult in 2023 because the signs and symptoms are not sensible nor specific. The consequences of potential diagnostic errors can be dramatic, whether by default or by excess. Furthermore, the achievement of a simple diagnostic strategy, based on clinical probability assessment, D-dimer measurement and computed tomography pulmonary angiography (CTPA) leads to a new challenge for PE diagnosis: over-testing. Indeed, since the 2000s, the wide availability of CTPA resulted in a major increase in investigations with a mod I confirm erate increase in PE diagnosis, without any notable improvement in patient outcomes. Quite the contrary, the complications of anticoagulation for PE increased significantly, and the long-term consequences of imaging diagnostic radiation is an important concern, especially the risk of breast cancer for young women. As a result, several strategies have been proposed to fight over-testing. They are mostly based on defining a subgroup of patients for whom no specific exam should be required to rule-out PE and adjusting the D-dimer cutoff to allow the exclusion of PE without performing CTPA. This narrative review presents the advantages and limitations of these different strategies as well as the perspective in PE diagnosis.
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spelling pubmed-100932782023-04-13 How to Combat Over-Testing for Patients Suspected of Pulmonary Embolism: A Narrative Review Roy, Pierre-Marie Moumneh, Thomas Bizouard, Thomas Duval, Damien Douillet, Delphine Diagnostics (Basel) Review The diagnosis of PE remains difficult in 2023 because the signs and symptoms are not sensible nor specific. The consequences of potential diagnostic errors can be dramatic, whether by default or by excess. Furthermore, the achievement of a simple diagnostic strategy, based on clinical probability assessment, D-dimer measurement and computed tomography pulmonary angiography (CTPA) leads to a new challenge for PE diagnosis: over-testing. Indeed, since the 2000s, the wide availability of CTPA resulted in a major increase in investigations with a mod I confirm erate increase in PE diagnosis, without any notable improvement in patient outcomes. Quite the contrary, the complications of anticoagulation for PE increased significantly, and the long-term consequences of imaging diagnostic radiation is an important concern, especially the risk of breast cancer for young women. As a result, several strategies have been proposed to fight over-testing. They are mostly based on defining a subgroup of patients for whom no specific exam should be required to rule-out PE and adjusting the D-dimer cutoff to allow the exclusion of PE without performing CTPA. This narrative review presents the advantages and limitations of these different strategies as well as the perspective in PE diagnosis. MDPI 2023-04-03 /pmc/articles/PMC10093278/ /pubmed/37046544 http://dx.doi.org/10.3390/diagnostics13071326 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Roy, Pierre-Marie
Moumneh, Thomas
Bizouard, Thomas
Duval, Damien
Douillet, Delphine
How to Combat Over-Testing for Patients Suspected of Pulmonary Embolism: A Narrative Review
title How to Combat Over-Testing for Patients Suspected of Pulmonary Embolism: A Narrative Review
title_full How to Combat Over-Testing for Patients Suspected of Pulmonary Embolism: A Narrative Review
title_fullStr How to Combat Over-Testing for Patients Suspected of Pulmonary Embolism: A Narrative Review
title_full_unstemmed How to Combat Over-Testing for Patients Suspected of Pulmonary Embolism: A Narrative Review
title_short How to Combat Over-Testing for Patients Suspected of Pulmonary Embolism: A Narrative Review
title_sort how to combat over-testing for patients suspected of pulmonary embolism: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10093278/
https://www.ncbi.nlm.nih.gov/pubmed/37046544
http://dx.doi.org/10.3390/diagnostics13071326
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