Search

Pulmonary embolism (PE) can present with a range of severity. Prognostic risk stratification is important for efficacious and safe management. This second of two review articles discusses the management of high-, intermediate- and low-risk PE. We discuss strategies to identify patients suitable for urgent outpatient care in addition to identification of patients who would benefit from thrombolysis. We discuss specific subgroups of patients where optimal treatment differs from the usual approach and identify emerging management paradigms exploring new therapies and subgroups., Competing Interests: Competing interests: DEH was a topic expert for NICE NG158 and QS201, regarding the diagnosis and management of venous thromboembolic disease and venous thromboembolism in adults, respectively. DEH was also a coauthor on the BTS guidelines for the outpatient management of PE and the accompanying national quality standards. JC, PS, KdW and MJR have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

This first of two practice reviews addresses pulmonary embolism (PE) diagnosis considering important aspects of PE clinical presentation and comparing evidence-based PE testing strategies. A companion paper addresses the management of PE. Symptoms and signs of PE are varied, and emergency physicians frequently use testing to 'rule out' the diagnosis in people with respiratory or cardiovascular symptoms. The emergency clinician must balance the benefit of reassuring negative PE testing with the risks of iatrogenic harms from over investigation and overdiagnosis., Competing Interests: Competing interests: JC, PS, KdW and MJR have no conflicts of interest to declare. DEH was a topic expert for NICE NG158 and QS201, regarding the diagnosis and management of venous thromboembolic disease and venous thromboembolism in adults, respectively. DEH was also a coauthor on the BTS guidelines for the outpatient management of pulmonary embolism and the accompanying national quality standards., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)