Reproducibility of Pretest Assessment in Suspected Pulmonary Embolism

Pulmonary embolism (PE) is a leading cause of mortality in North America. Prompt recognition and treatment of PE with anticoagulant therapy reduces the risk of mortality from 30% to 1.5%. Unfortunately, timely diagnosis of PE can be difficult because the clinical features of PE, such as chest pain and rapid heart rate, are not unique to PE. Although clinical assessment alone cannot confirm or exclude PE, it can be used to stratify patients according to their likelihood of having PE before diagnostic tests are performed (ie, pretest probability). This paper will review the role of clinical assessment in the diagnosis of PE, provide an overview of validated clinical prediction rules for PE, and discuss the reproducibility of clinical pretest probability assessment in suspected PE.