[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.161.157.73. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Article
November 28, 1990

The Diagnosis of Pulmonary Embolism-Reply

Author Affiliations

Rush-Presbyterian—St Luke's Medical Center Chicago, Ill

Rush-Presbyterian—St Luke's Medical Center Chicago, Ill

JAMA. 1990;264(20):2625. doi:10.1001/jama.1990.03450200031017

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

Abstract

In Reply.—  I agree with Dr Laks' comments that aggressive investigations into the diagnostic accuracy of combinations of noninvasive determinations and ventilation/perfusion scanning are needed. While we are waiting for such studies, clinicians need to have some basis for decision making, using information currently available. The PIOPED study looked at the diagnostic accuracy of clinical suspicion of pulmonary embolism and the ventilation/perfusion scan.Dr Laks' statements, however, are not relevant for the patient with normal findings from noninvasive leg studies. The PIOPED study did not address impedence plethysmography and duplex ultrasound, yet these techniques are used in patients with suspected pulmonary embolism. One is left, then, with balancing the associated risk-benefit ratios of angiogram vs anticoagulation for a patient who may or may not have pulmonary embolism. The relative risk of anticoagulation is greater than the risks inherent to angiography.Also, a relative bias exists when the diagnosis of pulmonary

×