A proposed diagnostic approach could reduce computed tomography pulmonary angiography use by 28% to 58%, according to a report. Professor Joseph Osterwalder outlined the unvalidated step-by-step approach to help clinicians streamline assessments for suspected pulmonary embolism.
The strategy separates patients based on haemodynamic stability to determine the correct sequence of diagnostic tests. For unstable patients, clinicians perform focused cardiac ultrasound first. Treatment starts immediately if that scan is positive without signs of chronic right ventricular dysfunction. Lower extremity compression ultrasonography follows if chronic signs appear.
Stable patients undergo lower extremity compression ultrasonography as the initial test. If that imaging returns positive, doctors skip further diagnostic scans while still performing focused cardiac ultrasound for risk stratification. Negative results lead to lung ultrasound next.
“If all three ultrasound modalities are negative or the findings remain inconclusive, proceed to CTPA,” Osterwalder warned, as healthcare-in-europe.com reported.
Dr Senad Tabakovic serves as Lead Consultant of the Emergency Department at Zürich City Hospital in Switzerland. He also acts as Co-Chair of the European Society for Emergency Medicine Ultrasound Section. Professor Joseph Osterwalder previously worked as Chief Physician at Cantonal Hospital St Gallen and currently serves as Chief Medical Officer at Polipraxis CH-9000.
The proposed workflow relies heavily on point-of-care ultrasound to reduce radiation exposure and hospital resource use. Haemodynamically stable patients with negative compression ultrasonography undergo lung ultrasound. A positive lung ultrasound still requires focused cardiac ultrasound for proper risk stratification.
Clinicians order a computed tomography pulmonary angiography scan only when all three ultrasound modalities return negative results or the findings remain inconclusive.
Professor Joseph Osterwalder, a recognized pioneer of point-of-care ultrasound and former Chief Physician at Cantonal Hospital St Gallen, pointed to the proposed approach.