Score
1
1
PTP Score
<2
2
Discharge - no DVT
US
US
US
Discharge - no DVT
TREAT
1. Wells PS, Anderson D et al. Evaluation of D-dimer in the Diagnosis of Suspected Deep Vein
Thrombosis N Engl J Med. Sept 25, 2003 349(13): 1227-35
DVT unlikely
DVT likely
No DVT - Follow up
Serial US
TREAT
No DVT - Follow up
Legend: US - Bi-lateral leg vein ultrasonography, LMWH - Low molecular weight heparin
PE Decision Rule
Procedure
1. Refer to the PE Pre-Test Probability Score Table. Add up the score and determine the patients pre-test probability for PE.
2. Refer to the PE Diagnostic Algorithm. According to the pre-test probability follow the relevant diagnostic algorithm.
PTP Score
Low Probability
<2.0
Moderate Probability 2.0 - 6.0
High Probability
>6.0
Score
Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins)
3.0
3.0
1.5
1.5
Previous DVT/PE
1.5
Hemoptysis
1.0
1.0
2. Wells P.S., Anderson D. et al. Derivation of a simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with
SimpliRED D-dimer. Thromb Haemost 2000;83:416-20
PE Diagnostic Algorithm
LOW
MODERATE
HIGH
D-dimer
D-dimer
D-dimer
VQ/CT Scan
VQ/CT Scan
PE Excluded
VQ/CT Scan
Normal
High
Non-high
PE Excluded
+
TREAT
PA or
other
tests
High
Non-high
PE Excluded
TREAT
US
US
US
PE Excluded
Normal
TREAT
Manage according to
initial D-dimer result
PE Excluded
+
US
Normal
Non-high
High
US
TREAT
PE Excluded
Manage according to
initial D-dimer result
PE Excluded
in 1 week
TREAT
PA or US
in 1 week
+
TREAT
+
TREAT
Legend: US - Bi-lateral leg vein ultrasonography, PA - Pulmonary Angiography, VQ - Ventilation/Perfusion Scan, CT Computed Tomography
3. Kline JA, Wells PS. Methodology for a rapid protocol to rule out pulmonary embolism in the emergency department. Ann Emerg Med 2003; 42: 266-76.
This educational tool provided by Wampole Laboratories and Unipath Ltd, distributors of
For more information visit www.wampolelabs.com or www.unipath.com
CMH225-B