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Pulmonary Embolism: Sensitivity and Specificity

Introduction: Diagnosis of PE and DVT often merge, so diagnostic studies have been listed here for both. Also, see UpToDate article http://www.utdol.com/online/content/topic.do?topicKey=ven_pulm/6608 for details.

For presenting signs/symptoms, this is a great article: Am J Med. 2007 Oct;120(10):871-9. PMID: 17904458

Also note that Chronic Thromboembolic Pulmonary Hypertension is a different matter.

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: Hematologic Pulmonary Tag this Diagnosis.

Prevalence

Population / CalculatorPrevalence Comments / Study / Link
Patients suspected of having PE 19.9% in+outpatients referred for V/Q scan

Am J Respir Crit Care Med. 2000 Dec;162(6):2105-8. PMID: 11112122

Well's criteria for PE 0% Follow this link to a pre-test probability calculator for PE

http://www.mdcalc.com/wells-criteria-for-pulmonary-embolism-pe/

Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer.

Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J.

http://www.schattauer.de/index.php?id=1268&pii=th00030416&no_cache=1

More, Edit...

The sensitivity and specificity of findings for Pulmonary Embolism are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %. Post-Test Probability (Predictive Value): %. Switch to display mode.
**Note that calculating probabilities from more than one finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)
Sensitive and Specific Findings
FindingResult SensitivitySpecificity
[ + ] Leg US + 0 - 93%98%
[ + ] MRA and MRV + 0 - 92%96%
[ + ] CT angiography + 0 - 90%95%
Specific Findings
FindingResult SensitivitySpecificity
[ + ] V/Q scan + 0 - 77%98%
[ + ] Doppler Ultrasound + 0 - 29%97%
[ + ] Abnormal Cardiac Exam + 0 - 22%88%
[ + ] No Typical Symptoms + 0 - 12%87%
Sensitive Findings
FindingResult SensitivitySpecificity
[ + ] Arterial Oxygen, D-dimer, or Respiratory Rate + 0 - 96.9%21.3%
[ + ] Elevated D-dimer + 0 - 95%25%
[ + ] Arterial Blood Gas or History of DVT + 0 - 92.1%21.1%
[ + ] Arterial Oxygen or History of DVT + 0 - 91.9%32.4%
[ + ] Arterial Blood Gas + 0 - 91.9%14.7%
[ + ] ECG Sensitivity = 86.5%
Negative Findings
FindingResult SensitivitySpecificity
[ + ] No Typical Symptoms + 0 - 12%87%
[ + ] Chest Pain + 0 - 17%79%
[ + ] Pleuritic Chest Pain or Hemoptysis + 0 - 44%44%
[ + ] Pleuritic Chest Pain + 0 - 47%41%
Poorly Diagnostic Findings
FindingResult SensitivitySpecificity
[ + ] Calf or Thigh Swelling + 0 - 39%80%
[ + ] Homan's Sign + 0 - 33%79%
[ + ] Signs of DVT + 0 - 47%77%
[ + ] Calf or Thigh Pain + 0 - 42%75%
[ + ] Dyspnea + 0 - 36%74%
[ + ] Abnormal Lung Exam + 0 - 37%64%
[ + ] pro BNP + 0 - 60%62%
[ + ] Tachypnea + 0 - 57%53%
[ + ] Arterial Blood Gas + 0 - 84.2%27.4%
[ + ] Tachycardia Sensitivity = 60%
[ + ] T-Wave Inversion Sensitivity = 49%
[ + ] Low ECG Voltage Sensitivity = 29%
[ + ] S1 Q3 T3 Pattern Sensitivity = 27.5%
[ + ] Right Bundle Branch Block Sensitivity = 22%