Odense Respiratory Research Unit, University of Southern Denmark, Odense, Denmark; Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Danish Society of Thrombosis and Hemostasis, Roskilde, Denmark.
Lancet Haematol. 2023 Nov;10(11):e922-e935. doi: 10.1016/S2352-3026(23)00181-3. Epub 2023 Oct 4.
Pulmonary embolism is one of the leading causes of death due to cardiovascular disease. Timely diagnosis is crucial, but challenging, as the clinical presentation of pulmonary embolism is unspecific and easily mistaken for other common medical emergencies. Clinical prediction rules and D-dimer measurement allow stratification of patients into groups of expected prevalence and are key elements in adequate selection of patients for diagnostic imaging; however, the strengths and weaknesses of the multiple proposed prediction rules, when to measure D-dimer, and which cutoff to apply might be elusive to a significant proportion of physicians. 13 international guidelines authored by medical societies or expert author groups provide recommendations on facets of the diagnostic investigations in suspected pulmonary embolism, some of which are hallmarked by pronounced heterogeneity. This Review summarises key recommendations of each guideline, considers the most recent evidence on the topic, compares guideline recommendations on each facet of the diagnosis of pulmonary embolism, and provides a synthesis on the most common recommendations.
肺栓塞是心血管疾病导致死亡的主要原因之一。及时诊断至关重要，但具有挑战性，因为肺栓塞的临床表现不具特异性，容易与其他常见的急症混淆。临床预测规则和 D-二聚体检测可将患者分为预期发生率不同的组别，是对疑似肺栓塞患者进行诊断性影像学检查进行适当选择的关键要素；然而，当测量 D-二聚体以及应用何种截断值时，多种已提出的预测规则的优势和劣势可能对相当一部分医生来说难以捉摸。13 个由医学协会或专家作者小组撰写的国际指南就疑似肺栓塞诊断性检查的各个方面提供了建议，其中一些方面的特点是明显的异质性。这篇综述总结了每个指南的关键建议，考虑了该主题的最新证据，比较了指南对肺栓塞诊断各个方面的建议，并对最常见的建议进行了综合。
