We all know that feeling when a colleague comes up to you with a grave look on their face and says, “You remember that patient you saw last week with….” On a good day the story might go that you admitted the patient to hospital, it turns out that they had a pulmonary embolism, and now they’re better. And on a bad day? Well, you’d better hope you made some good notes and, better still, followed a validated pulmonary embolism clinical decision rule. These are intended to answer the age-old question: “How do you know it isn’t a pulmonary embolism?” without always having to request a computed tomography pulmonary angiogram (CTPA). But CTPA testing seems to be going up regardless. A retrospective analysis of 26 emergency departments in six European countries found that, between 2015 and 2019, the rate of CTPA testing increased from 836 per 100 000 emergency department visits to 1112 per 100 000. The rate of diagnosis of pulmonary embolism went up too, but, as diagnosis went up, so did the proportion of low risk pulmonary …

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Tom Nolan 的研究评论——2023 年 6 月 1 日

我们都知道当一位同事面带严肃地走过来对您说：“您记得上周看的那个病人……”时的感觉。在美好的一天，故事可能会发生，你让病人入院，结果发现他们患有肺栓塞，现在他们好多了。在糟糕的一天？好吧，你最好希望你做了一些好的笔记，更好的是，遵循经过验证的肺栓塞临床决策规则。这些旨在回答这个古老的问题：“你怎么知道它不是肺栓塞？” 而不必总是要求进行计算机断层扫描肺血管造影 (CTPA)。但无论如何，CTPA 测试似乎都在上升。一项对欧洲六个国家 26 个急诊科的回顾性分析发现，在 2015 年至 2019 年期间，