Knowledge of the diagnostic algorithm for pulmonary embolism in primary care

• Pulmonary embolism concerns general practitioners who are the first medical recourse.
• The majority of GPs are still unaware of the diagnostic algorithm for pulmonary embolism.
• D-dimers are performed in primary care but knowledge about their negative predictive value remains poor.
• Specific training should improve knowledge of the diagnostic algorithm for PE among GPs.

BackgroundDiagnostic algorithms for pulmonary embolism (PE) have been validated in patients attending hospital emergency departments. However, general practitioners (GPs) are often the professionals of first resort for the majority of non-critical cases of PE.AimTo evaluate the knowledge of the diagnostic algorithm for PE among GPs in France.Design and settingQuestionnaire-based survey of GPs with a private practice.MethodAll GPs in the study area were sent a questionnaire including several questions on the diagnosis of PE and two clinical cases scenario with suspected PE. Factors associated with knowledge of the diagnostic algorithm were analysed by univariate and multivariate analyses.ResultsFive-hundred and eight questionnaires were distributed and 155 (30.5%) were available for analysis. Only 55% of the GPs did know about clinical scores for the assessment of clinical probability of PE and 42% of the GPs were aware that clinical probability is needed to interpret the result of D-dimer testing. Forty GPs (26%) gave valid responses to both clinical cases, 54 GPs (35%) had one valid case out of the two and 61 (39%) gave invalid responses to both clinical cases. Participation in specific training on PE was significantly associated with valid responses to the two clinical cases in multivariate analysis (p < 0.017).ConclusionThe majority of GPs were unaware of the diagnostic algorithm for PE. Clinical probability was rarely assessed and knowledge about D-dimers was poor. Specific training on PE and greater awareness of clinical probability scores may promote knowledge of PE algorithm diagnosis.