Schluger N, Henschke C, King T, Russo R, Binkert B, Rackson M, Hayt D
Division of Pulmonary and Critical Care Medicine, New York Hospital-Cornell Medical Center, New York.
J Thorac Imaging. 1994 Summer;9(3):180-4. doi: 10.1097/00005382-199422000-00013.
Pulmonary embolism (PE) is a common clinical entity, although the signs and symptoms that accompany it are nonspecific. This has led to the development of several diagnostic algorithms for diagnosis of PE. These approaches combine noninvasive tests such as ventilation/perfusion (V/Q) lung scanning, impedance plethysmography, and ultrasound, with invasive techniques such as venography and pulmonary angiography. To investigate the manner in which clinicians select and use these various diagnostic strategies, we retrospectively reviewed 316 consecutive cases of suspected PE to determine the sequence and type of diagnostic strategy employed by clinicians. We found that in the majority of cases, physicians chose not to further pursue a diagnosis of PE if the V/Q scan was nondiagnostic. These results suggest that physician behavior is often at variance with published clinical recommendations and that the implementation of clinical practice guidelines needs to be further examined.
肺栓塞（PE）是一种常见的临床病症，尽管与之相伴的体征和症状并无特异性。这导致了多种用于诊断PE的诊断算法的发展。这些方法将诸如通气/灌注（V/Q）肺扫描、阻抗体积描记法和超声等非侵入性检查，与诸如静脉造影和肺血管造影等侵入性技术相结合。为了研究临床医生选择和使用这些不同诊断策略的方式，我们回顾性分析了316例连续的疑似PE病例，以确定临床医生采用的诊断策略的顺序和类型。我们发现，在大多数病例中，如果V/Q扫描无法确诊，医生不会进一步寻求PE的诊断。这些结果表明，医生的行为往往与已发表的临床建议不一致，临床实践指南的实施需要进一步研究。
