Decision Moments and Pulmonary Embolism Diagnostic Quality in the Emergency Department - Summary - MDSpire
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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

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Objective:

To evaluate clinician variation at key decision moments in the diagnosis of pulmonary embolism (PE) and its association with diagnostic outcomes.

Approach:
  • Study Design: A multisite retrospective cohort study across 29 hospital-based EDs in Michigan, analyzing data from approximately 5.1 million ED visits.
  • Data Collection: Utilized MEDIC clinical data registry to extract demographic characteristics, triage level, disposition, vital signs, PE testing, and clinician identifiers.
  • Decision Moments: Focused on three key decision moments: testing for PE, selection of initial testing modality, and interpretation of D-dimer results.
Key Findings:
  • CTPA diagnostic yield and missed opportunities for PE diagnosis were assessed.
  • Risk stratification commonly begins with the Wells criteria and D-dimer assays.
  • The D-dimer assay serves effectively as a rule-out test, particularly in lower-risk populations.
Limitations:
  • Exclusions included visits with CTPA in children, trauma activations, and imaging not related to acute PE.
  • The study relied on deidentified data, which may limit the granularity of insights.

Original Source(s)

Decision Moments and Pulmonary Embolism Diagnostic Quality in the Emergency Department

  • 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

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