Critical Decision Points and the Quality of Pulmonary Embolism Diagnosis in Emergency Settings
By
Alexander T. Janke
Christopher M. Fung
Matthew C. Bombard
Seth Krupp
J. Adam Oostema
Daniel L. Overbeek
Matthew Hysell
James H. Paxton
Giuseppe Perrotta
Brett Todd
Lauren M. Westafer
Geoffrey D. Barnes
Colin F. Greineder
Keith E. Kocher
September 22, 2026
Clinical Scorecard: Critical Decision Points and the Quality of Pulmonary Embolism Diagnosis in Emergency Settings
At a Glance
Category Detail
Condition Pulmonary Embolism (PE) Key Mechanisms Risk stratification tools and D-dimer assays to guide testing decisions. Target Population Patients presenting to the emergency department with suspected PE. Care Setting Emergency Department
Key Highlights
CTPA imaging for PE has quadrupled despite evidence-based strategies. Risk stratification often begins with the Wells criteria. D-dimer assays serve as effective rule-out tests, especially in lower-risk populations. The Pause Pre PE algorithm focuses on key decision moments in PE testing. Standardizing ED testing remains challenging due to overtesting and missed diagnoses. Guideline-Based Recommendations
Diagnosis
Utilize Wells criteria for initial risk assessment. Apply PE Rule Out Criteria for very low-risk patients. Management
Start with D-dimer assay before CTPA unless clinical suspicion is high. Monitoring & Follow-up
Evaluate CTPA diagnostic yield and missed opportunities for PE diagnosis. Risks
Radiation exposure from imaging, overdiagnosis from false positives, increased ED stay times, and associated costs. Patient & Prescribing Data
ED patients with suspected pulmonary embolism.
Age-adjusted D-dimer interpretation is recommended for better diagnostic accuracy.
Clinical Best Practices
Implement the Pause Pre PE algorithm to enhance decision-making. Standardize the use of D-dimer assays in conjunction with clinical judgment. Related Resources & Content
