The American College of Physicians (ACP) has issued clinical guidelines offering best practice advice for the evaluation of patients with suspected acute pulmonary embolism (PE). Best practice advice for clinicians in the evaluation of adults, both inpatient and outpatient, suspected of having acute PE, includes:

• Use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being published.

• Do not obtain D-dimer measurements or imaging studies in patients with a low pretest probability of PE and who meet all Pulmonary Embolism Rule-Out Criteria.

• Obtain a high-sensitivity D-dimer measurement as the initial diagnostic test in patients who have an intermediate pretest probability of PE or in patients with low pretest probability of PE who do not meet all Pulmonary Embolism Rule-Out Criteria. Do not use imaging studies as the initial test in patients who have a low or intermediate pretest probability of PE.

• Use age-adjusted D-dimer thresholds in patients older than 50 years to determine whether imaging is warranted.

• Do not obtain imaging studies in patients with D-dimer level below the age-adjusted cutoff.

• Clinicians should obtain imaging with CT pulmonary angiography (CTPA) in patients with high pretest probability of PE. Clinicians should reserves ventilation-perfusion scans for patients who have a contraindication to CTPA or if CTPA is not available.

Citation: Raja AS, Greenberg JO, Qaseem A, et al. Evaluation of patients with suspected acute pulmonary embolism: Best practice advice from the Clinical Guidelines Committee of the American College of Physicians. [Published online ahead of print September 29, 2015]. Ann Intern Med. doi: 10.7326/M14-1772.