Non-conform diagnostic management of pulmonary embolism suspected patients is responsible for a higher risk of thrombotic event occurrence

The aim of this 3-month follow-up prospective pragmatic study was to evaluate the implementation of a pulmonary embolism (PE) diagnostic strategy in clinical practice. One thousand and one hundred thirty-four consecutive in- and outpatients with clinically suspected PE were enrolled into a sequential diagnostic algorithm in which vascular medical unit plays a pivotal role in advising physicians and suggesting the most appropriate tests according to the diagnostic algorithm. In this observational study, patients that followed the proposed work-up were attributed to a so-called “conform group”. Patients in whom diagnostic work-up was not according to protocol were attributed to a “non-conform group”. Nine hundred and ninety-seven patients (87.9%) had a conform work-up, and 137 patients a non-conform work-up according to the proposed diagnostic algorithm. The non-conform work-up directly increased in relation to the age of the referred patients. PE was ruled out in 907 (80%) patients of whom 787 (86.8%) were in the conform group. Of the 797 patients who did not receive anticoagulant drugs, follow-up was obtained in 792 (99.4%). Among these patients, the incidence of acute thromboembolic events during the 3-month follow-up period was different in the group of patients that had a conform work-up (1%, [95% CI, 0.5–2.1%]) from the non-conform group patients (4.5%, [95% CI, 2–10.2%]. Therefore patients from the non-conform group have an independent increased risk to develop a thromboembolic event during the follow-up, adjusted odds ratio 3.3 [1.1–10, 95% CI]. Therefore we demonstrated that a non-conform diagnostic management strategy is associated with a higher risk of thrombotic event occurrence. Le but de cette étude prospective observationnelle était d'évaluer l'efficacité d'une stratégie diagnostique d'embolie pulmonaire (EP) en pratique clinique. Mille cent trente-quatre patients consécutifs, hospitalisés ou admis en service d'urgence, et suspects d'embolie pulmonaire, ont été investigués selon un algorithme diagnostique dans lequel l'unité de médecine vasculaire joue un rôle central en suggérant la réalisation des tests les plus appropriés, conformément à la règle mise en place. Dans cette étude observationnelle, les patients qui suivaient le protocole diagnostique constituaient le groupe « conforme ». Les patients pour lesquels la démarche diagnostique s'écartait du consensus constituaient le groupe « non-conforme ». Neuf cent quatre-vingt-dix-sept patients