Patient stratification by cardiopulmonary status in the diagnosis of pulmonary embolism.

Abstract

The purpose of this investigation is to provide further evidence in support of the interpretation of ventilation/perfusion (V/Q) lung scans on the basis of criteria dependent on whether or not the patient has prior cardiopulmonary disease (CPD). Data are from the collaborative PIOPED study. We evaluated the original PIOPED database to obtain the consensus probability estimates of pulmonary embolism (PE) among patients stratified according to the presence or absence of prior CPD. Among patients with no prior CPD, nuclear physicians consistently underestimated the probability of PE (odds ratio 1.62, 95% confidence interval 1.10-2.38, p = .014). Past experience guided nuclear physicians into correctly estimating the probability of acute PE on V/Q scans of patients with prior CPD. The criteria they subjectively used was inadequate for estimating the probability of acute PE in patients with no prior CPD. Different criteria, therefore, apply to the interpretation of V/Q scans in these two groups.