Guideline-Directed PE Care: The Diagnostic Tools You Need at the Bedside

In part one of this two-part episode, MDCalc cofounder and CEO, Dr. Joe Habboushe, talks with Dr. Eric Steinberg about how to actually diagnose a pulmonary embolism — and considering scenarios in which the biggest risk in PE workup may not be the disease itself, but the testing we order to find it. A conversation about pretest probability, when a CT scan does more harm than good, and how to use clinical tools without losing the judgment they're supposed to support.

Dr. Habboushe and Dr. Steinberg have been talking through PE cases together for close to two decades, since Dr. Steinberg was a resident under Dr. Habboushe's supervision. Their conversation was prompted by new multi-society PE guidelines, released this year, which spotlight eight clinical tools out of the 36 PE-related calculators on MDCalc. In this episode, they focus on the diagnostic side: how to establish pretest probability, when the PERC rule applies and when it doesn't, and why the D-dimer test causes more confusion than almost anything else in emergency medicine.

Dr. Steinberg and Dr. Habboushe also walk through a common misconception about the YEARS algorithm, why age-adjusted and altitude-adjusted versions of these tools exist, and what it actually means to communicate a low-risk result to a patient who came in expecting a scan.

What You'll Learn

• Why scanning every patient isn't the safe default, and how incidental findings and false positives can cause more harm than the small risk of missing a PE
• Why the PERC rule is a one-directional tool: failing it doesn't raise a patient's risk, it just means the rule no longer applies
• How to choose between Wells and Geneva based on clinical experience, and why Geneva's objectivity makes it a better starting point for trainees
• Why the D-dimer's negative predictive value, not its false positive rate, is the piece most clinicians misunderstand
• Why the YEARS algorithm is often mistaken for a pregnancy-only tool, and what its flexible D-dimer threshold actually does

Links & Resources

DVT and PE Tool Collection

MDCalc: mdcalc.com

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