MEDICAL HYPOTHESES AND RESEARCH
VOL. 3, No. 1, January 2006



A. Blum, et al. [2006] Med Hypotheses Res 3: 623-628.


Diagnosing Pulmonary Emboli: Importance of Clinical
Assessment


Arnon Blum, *Michal Mashiach Eizenberg and Claudia Simsolo


Abstract. Background: Pulmonary embolism (PE) is a common condition that
challenges physicians to make accurate and timely diagnosis. Clinicians frequently use their
own experience to determine the pretest probability of PE, although in the last years scoring
systems have been promoted as more reliable than subjective assessment. Methods: This was
a retrospective study of patients that were admitted with a suspected diagnosis of PE. There
were 62 patients, 33 women and 29 men, aged 63.45 ± 19.65 years old.  All patients were
admitted with a suspected diagnosis of PE; all had a D-dimer test and a spiral chest
computed tomography. Results: In women older than 50 years of age (27 women, mean age
68.40 ± 20.00 years) the clinical score was predictive of the final diagnosis of PE (B = 0.689, P
< 0.05). The probability of diagnosing PE in this group was correlated with the clinical score,
so that at 1 point the probability was 3%, at 2 points the probability was 6.9%, at 3 points it
increased to 12.9%, at 4 points 22.8%, at 5 points 37%, and at 6 points 54%. When each
clinical variable and its predictive value to diagnose PE (Fisher exact test) were analyzed, it
was found that only the clinical parameter of immobility or surgery within the last month
were predictive of PE (P = 0.003). Conclusion: Our data showed that PE could be predicted
only in women older than 50 years of age and only based on clinical parameters. D-dimer
levels determined by an ELISA method (not by the VIDAS D-dimer method) did not predict
or exclude PE in any group of patients. Larger prospective studies are needed to validate our
findings.    


*Address all correspondence to: Dr. Claudia Simsolo, Department of Internal
Medicine A, Baruch-Padeh Poriya Medical Center, Lower Galilee 15208, Israel.
Telephone and Fax: 972-4-6652687. E-mail:
csimsolo@poria.health.gov.il




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