Rationale:
CT angiography carries risks related to radiation exposure and contrast reactions and should only be performed when clearly indicated. Modern diagnostic approaches for venous thromboembolism should include an assessment of pre-test probability. In hemodynamically stable patients with a low or intermediate clinical probability score (e.g., Geneva or Wells) and a negative high-sensitivity D-dimer test, the negative predictive value for pulmonary embolism is approximately 99%. In such cases, further imaging studies are not recommended.
References:
- Wendy Lim, Grégoire Le Gal, Shannon M. Bates, Marc Righini, Linda B. Haramati, Eddy Lang, Jeffrey A. Kline, Sonja Chasteen, Marcia Snyder, Payal Patel, Meha Bhatt, Parth Patel, Cody Braun, Housne Begum, Wojtek Wiercioch, Holger J. Schünemann, Reem A. Mustafa; American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv 2018; 2 (22): 3226–3256. doi:
- Thrombosis Canada Clinical Guide: Pulmonary embolism. https://thrombosiscanada.ca/wp-content/uploads/2020/03/Pulmonary-Embolism-Diagnosis_23Jan-2020.pdf
- Stavros V Konstantinides, Guy Meyer, Cecilia Becattini, Héctor Bueno, Geert-Jan Geersing, Veli-Pekka Harjola, Menno V Huisman, Marc Humbert, Catriona Sian Jennings, David Jiménez, Nils Kucher, Irene Marthe Lang, Mareike Lankeit, Roberto Lorusso, Lucia Mazzolai, Nicolas Meneveau, Fionnuala Ní Áinle, Paolo Prandoni, Piotr Pruszczyk, Marc Righini, Adam Torbicki, Eric Van Belle, José Luis Zamorano, ESC Scientific Document Group, 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC), European Heart Journal, , ehz405