Facteurs prédictifs et éléments diagnostiques de l'embolie pulmonaire aux urgences

Suspected pulmonary embolism is a frequent and complex situation. Appropriate diagnostic management must take into account the patient's medical history and their signs and symptoms and to perform one or several specific tests. The first step is the assessment of the clinical probability of pulmonary embolism (PE) in order to choose the best test to perform and to interpret the result. Several decision rules have been validated for this purpose. When the clinical probability is low or intermediate, a d-dimer test is indicated whereby a negative result excludes pulmonary embolism. When the clinical probability is high or the d-dimer test is positive, a lung spiral computed tomography may be performed. A positive test rules in and a negative test usually rules out pulmonary embolism. When the clinical probability is high, in order to exclude pulmonary embolism with confidence, a negative computed tomography result may be strengthened further by a negative vein leg exploration. However, this recently validated algorithm is not always suitable (massive PE, previous anticoagulation, renal insufficiency, allergy…). The choice of an appropriate strategy, especially in such complex situations, may be helped by a computerized clinical decision support system.