The Diagnosis of Pulmonary Embolism

Mitchell Phillip Laks, MD, PhD
JAMA. 1990;264(20):2624-2625. doi:10.1001/jama.1990.03450200031016.
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To the Editor. —  In Dr Bone's1 editorial accompanying the publication of the PIOPED study in JAMA,2 the algorithm for the workup of a patient with a clinically suspected pulmonary embolism and hypoxemia mandates a pulmonary angiogram in patients with a high-probability ventilation/perfusion scan if a noninvasive study (impedance plethysmography or duplex ultrasound) yields normal results. Although it is intriguing to speculate on how results from these other noninvasive tests should modify our triage of patients, there is no evidence suggesting that all these patients require an angiogram.The PIOPED study has shown that a high-probability scan has a sensitivity and specificity of 41% and 97%, respectively, which for a population with a prevalence of pulmonary embolism of 33% (about average for the literature) corresponds to a positive predictive value of 88% for pulmonary embolism (or 91% for patients with no history of prior pulmonary embolism). Certainly, an


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